Creative Musical Play: An Innovative Approach to Early Childhood Music Education in an Urban Community School of Music
By BINA ANN JOHN, LINDA CAMERON, AND LEE BARTEL
University of Toronto, Canada
Published in Action, Criticism, and Theory for Music Education 15 (3): 21–36. [pdf]
Music is a distinct form of communication that manifests naturally when children are engaged in musical play regardless of their cultural backgrounds. In an ethnically diverse, urban community music school, where the majority of children represent non-western populations, the need for creativity-focused approaches that do not assume a western classical orientation is especially critical. The purpose of this study is to explore an innovative approach in early childhood music education that highlights creative musical play. Data analyses revealed that social and shared regulation behaviors manifested most consistently in the free exploration forms of creative musical play. Guided musical play and free exploration elicited more positive emotions than the musical play elicited during rituals. The findings of this study reveal the potential for creative musical play to enhance musical communication by nurturing children’s capacities to communicate and relate to each other.
Keywords: creative musical play, community music, culturally diverse populations, tools of learning, early childhood
Current research findings highlight the universal nature of musical communication that develops through musical play from birth to early childhood regardless of the musical culture that a child is born into. According to Ellen Dissanayake (2009), “musicality is a psychobiological capacity that underlies all human communication, including music” (17). Through musical play, children naturally acquire both the musical practices of their own culture, as well as “an imaginative musicianship of their own. While learning the arts of music, they create their own musical inventions, playing a role in the changes that transform musical cultures across generations, through processes that are independent of adult intervention” (Malloch and Trevarthen 2009, 467). Music and musical play are essential forms of communication that provide “a means by which people can share emotions, intentions, and meanings”(Miell, MacDonald, and Hargreaves 2005, 1). This vital connection between musical play and musical communication needs further exploration. Musical play is a “very under-researched area, despite being a ubiquitous and highly significant form of play in all human cultures” (Whitbread 2012, 22).
The sociocultural significance of musical play seems even more critical in urban community music schools. As Claudia Gluschankof (2008) points out, more research is needed to examine “children’s self-initiated musical expressions in non-western communities”(325). The musical expressions of children from diverse cultural backgrounds are inherently ‘multi-musical’ (Kelly 2016, 6). This requires an investigation of what forms of musical play celebrate multi-musicality. We need innovative approaches that do not assume “the embedded conceptions of children developing in steps toward assumed endpoints defined by adult music making in Western art music tradition” (Young 2009, 696). Unfortunately, the majority of early childhood music classes in Toronto, Canada, favor a Western classical orientation over creativity-focused approaches that are based on and inspired by the natural musical behaviors that emerge when children are allowed to play on their own. An innovative approach “consciously appreciates and shares the spontaneous, creative, and perhaps anarchic musicality that the child already possesses, inside, as motives for living and learning with companions” (Flohr and Trevarthen 2008, 55).
A close examination of the social and emotional interactions that evolve between one child and another and between children and teachers in musical spaces that encourage students from diverse cultural and linguistic backgrounds to freely discover their own musical meanings in multiple contexts may shed light on the link between musical play and musical communication. This study will examine what forms of musical play reveal the most potential to enhance musical communication in an urban community music school.
Theoretical Framework: Play and Musical Play
Play within a social context, such as early childhood music classes in an urban community music school, provides valuable opportunities for children to “regulate their emotions” and “make friends and learn to get along with others as equals” (Gray 2001, 455–6). Gray observes that in the absence of social play, “children fail to acquire the social and emotional skills that are essential for healthy psychological development” (458). This is especially significant in the light of current research on the play of children belonging to many different cultures. Citing the research of P. G. Ramsey (2006), Doris Bergen (2015) observes, “often children of differing racial/ethnic or socioeconomic backgrounds do not even have opportunities to play together, and when they do their varied experiences may make their play behaviors unsynchronized” (61).
There exists a paucity of research that addresses the potential for music to inform and coordinate play behaviors within culturally and linguistically diverse settings. Smith and Montgomery’s (2007) impressive historical overview of research on free musical play does provide significant insights. Themes that emerge from their findings include the importance of self-selection, prolonged periods of continuous free musical play, and the need to value the natural emergence of musical skills in the absence of adult intervention. Their research sheds light on the increased possibilities of musical play when viewed equally as an artistic and social practice. An exploration of the possible relationship that exists between musicality, a psychobiological potential, and musical play, a sociocultural practice, could provide valuable insights on how to approach music making in a culturally diverse, early childhood music class.
Tools of Learning
If music is a psychobiological capacity, the lens in which to observe and compare various forms of musical play may best be served by a theory that is grounded in a study of emotional development in childhood that addresses sociocultural as well as cognitive outcomes. This study is largely based on the theoretical constructs derived from the theories on the evolution of symbols and reflective thinking of Stanley Greenspan and Stuart Shankar (2004), specifically the notion of how we “maintain our humanness,” and how “emotions actually give birth to our very ability to create symbols and to think” (1).
The pioneering work of Greenspan (1993, 1997, 2000) questions child developmental theories that continue to promote the age-old split between affect and cognition. He challenges Jean Piaget’s emphasis on the need for infants to first manipulate physical objects in order to understand concepts such as causality. Greenspan (1997) observes “months before a baby is able to pull a string, however, he can pull his mother’s heartstrings with a smile and thereby elicit a hug, a kiss, or a smile” (35). Greenspan proposes “most children can classify their emotions and emotionally relevant relationships far earlier than they can physical objects” (35). Greenspan traces the development of emotions and affect through six stages that emerge in the first three years of life. Children continue to progress through these stages in a more refined manner between the ages of four and ten (John 2002).
In the first stage, the infant/child reveals the ability to attend to multisensory and affective experiences. While maintaining a regulated and calm state, the infant/child is able to experience pleasure. In the second stage, the infant/child should be able to engage with, and reveal affective pleasure and preference with others. When the child begins preschool or early educational experiences, healthy emotional development should be evidenced by the following milestones: (1) the ability to be calm, regulated, and attentive; (2) the ability to relate to others; (3) the ability to have intentional two-way nonverbal communication; (4) the ability to act on the world by engaging in a continuous flow of emotional interactions (5) the ability to have emotional ideas; and (6) the ability to exhibit emotional thinking through connecting ideas (Greenspan 2002, 45–55).
According to Greenspan and Shankar (2004), our biological potential for learning which includes the ability to perceive, organize, and respond, is a necessary but not sufficient condition for learning to take place. The sufficient condition for learning requires social and emotional tools of learning that “include the ability to attend, interact with others, engage in emotional and social signaling, construct complex patterns, organize information symbolically, and use symbols to think. These ‘tools’ enable us to develop knowledge, wisdom and empathy” (5). By understanding the critical and culturally mediated processes of music making that make us human, the potential to promote musical communication and a sense of belonging through musical play must be explored. Antonio Damasio’s (2010) neuroscientific research suggests that art and music “became a means to induce nourishing emotions and feelings, something at which music has excelled through the ages” (296). This necessitates a focused investigation on specific cultural developments (such as musical play) that Damasio aptly points out provide a key role in enhancing communication and a sense of self and others.
- What forms of musical play are elicited through this creativity-focused
approach to early childhood music education?
- What tools of learning emerge from these forms of musical play?
The fieldwork for this “bounded” exploratory case study focuses on “one particular setting during a prescribed period of time” (Froehlich and Frierson-Campbell 2013, 154). This study utilizes an ethnographic approach of naturalistic, non-participant observations of two early childhood music classes at the Regent Park School of Music, a community music school located in one of the most ethnically diverse, low-income neighborhoods in Toronto, Canada. The Regent Park School of Music’s mandate is to ensure that as many children as possible receive a music education by removing the burden of money or affordability. The children’s lessons are subsidized based on the total income reported by their families, which should be less than $30,000 a year.
Essential to this form of qualitative research is the need to acknowledge the subjectivities that are naturally manifest during the research process. According to Peshkin (1994), the affective, historical, and biographical aspects of the researcher will determine the direction of the research (47). In terms of affective subjectivities, I, Bina Ann John, support the values outlined in the Strategic Plan of the Regent Park School of Music, such as creativity, dedication, and enthusiasm as well as their mandate to provide high quality and affordable music education to young people in need which applies to children who do not have access to quality music education due to financial or any other reasons. The historical subjectivities include a unique position with the school as well as prior relationships with the director and staff. It should be noted that both the music teacher and the director of the school are former students of mine. Consequently, I was well aware of the director’s creative and non-conventional approaches to music education and his lived commitment for social justice through music. As an undergraduate student, the early childhood teacher was one of the most resourceful and very musically talented students I have ever taught. She was always that one student to think “out of the box!” I had a sense that her approach would be both innovative and inspiring. Shortly after the data were collected, I was invited to become a member of the Board of Directors as well as a member of the Educational Committee of the Regent Park School of Music. Both of these positions provided me with a very special vantage point to appreciate the successes and challenges of this unique school.
The two early childhood music classes at the Regent Park School of Music were chosen both for their culturally diverse populations and the willingness of the early childhood music teacher as well as director of the school to host the research study. Once the ethics application was approved, and letters of consent obtained, the observations were conducted over a period of five months.
The observational data collection methods used were videotaping, direct observation, transcription of observations, anecdotal notes, and an interview with the early childhood music teacher. The video camera was for the most part left in a fixed position and only moved when the view was obstructed by the nature of an activity or the presence of other adults. The observations consisted of two 60-minute classes on Saturday afternoons between 1:00–3:00 p.m. The Regent Park School of Music is housed in a new, state of the art community arts centre situated in an urban neighborhood in downtown Toronto. The large classroom is effectively designed with open windows and a carpet, providing a very open space in which to display an impressive array of donated instruments including a grand piano, mouth keyboards, stringed instruments, steel pans, snare drums, bucket drums, vibraphones, xylophones, and other percussion instruments.
As a non-participant observer, I interacted as minimally as possible with the children and chose a position slightly outside of the class formation. Finally, in terms of biographical subjectivities, my presence and my research assistant, Lorenzo Madrazo’s presence in the class did not seem to distract the children. Our Indian and Asian backgrounds may have enabled us to blend in with many of the parents observing their children.
The thirty-three children in these two culturally diverse classes were between four and six years old. In addition, the students all belonged to lower socioeconomic populations, as the classes are open only to children who belong to a specific income level. The Regent Park School of Music only offers subsidized music lessons.
Procedures and research tools
Approximately 18 hours of videotape were transcribed, analyzed, and coded, supported by the anecdotal written observations and a videotaped interview with the music teacher. The data retrieved from the video camera was downloaded to encrypted storage devices. Each session was viewed for a minimum of three times. Observations were transcribed several times, supported by the anecdotal written observations. All forms of musical play were documented and analyzed. The journals and anecdotal notes were arranged chronologically as well. An interview with the early childhood music teacher was recorded, transcribed and analyzed. The personal interview provided a context for the music classes as well as vital insights on the nature of the musical interactions.
Results, Analysis, and Discussion
1. What forms of musical play are elicited in this creativity-focused approach to early childhood music classes?
The forms of musical play that were elicited in the early childhood music classes at the Regent Park School of Music revealed an impressively wide range of music making opportunities. Every week presented the same hello songs and good-bye songs, followed by varying combination of musical games, movement games, as well as musical play built on spontaneous improvisation, guided composition, and free exploration. All forms of musical play were recorded and then categorized. Three distinct categories emerged: ritual, creative musical play, and guided musical play. The guided musical play category included musical games and movement activities that the teacher initiated and carried through to the end. The majority of the examples in the guided musical play category were comprised of either singing or moving to recorded music. In guided musical play, the “teacher or parent serves as a guide to the child’s exploration by asking questions or engaging in parallel play with the child” (Flohr and Trevarthen 2009, 87).
Creative musical play involved free exploration, spontaneous improvisation, and guided composition utilizing graphic scores that the children performed after the music teacher introduced them to the sounds of the instruments on an individual basis, or created a story with the entire group. What made this category distinct was the unrestricted and spontaneous play that seemed to consume the children’s attention and energy. It is this combination of freedom and musical engagement that according to Mihalyi Cziksentmihalyi (1996) enables the flow of creativity. This concept combined with Flohr and Trevarthen’s (2009) definition of free exploration, “the child is left alone to explore instruments” (87), inspired the construct of ‘creative musical play’. It is interesting to note that the creative musical play only involved experimenting with instruments and did not include the voice. A most fitting observation by Bannan and Woodward (2009) is that “in many languages, the word for musical engagement, especially with instruments, is play” (479).
Creative musical play was initiated by the teacher or the child, but followed through solely by the child. The teacher would first demonstrate how to play the instruments, followed by a discussion led by the teacher about how sounds were produced on each instrument. Only after an introduction, discussion, and opportunity to experiment with the sounds of all the instruments, under the supervision of the teacher, was the child invited to explore the instrument of his or her choice. Therefore, a distinction was made between guided musical play that could be facilitated by any adult, regardless of his/her musical expertise, and creative music play, where the latter form necessitated the expertise of a professional musician. Finally, when the musical play functioned as a welcoming song, or signaled the end of the class it was coded as a ritual. The ritual songs included the hello songs and good-bye songs that were led by the teacher. This final form of musical play involved both singing and playing musical instruments. Mercedes Pavlicevic (2003) defines ritual as a behavior that “seems to carry significant meaning for all in the room” (140). In the context of this study, rituals are defined by musical activities that are repeated in every music class to signify both the beginning and the ending of the class.
2. What tools of learning emerge from these forms of musical play?
What emerged from the primary analysis was the preponderance of two social behaviors, as further defined by Greenspan and Shankar (2004) as self and shared regulation behaviors and three distinct emotional responses that were best described as negative, positive, or vacant affect. The affective responses were analyzed by adapting the Minnesota Preschool Affect Checklist for Positive and Negative Affect (Denham 2015). The social regulation behaviors were coded according to Shankar’s (2013) constructs (See Figure 1). After identifying the five ‘tools of learning’, the social and emotional responses elicited by the three forms of musical play; ritual, guided musical play, and creative musical play were coded.
|Rituals||“musical behaviors that contain a specific meaning”
(Pavlicevic 2003, 140)
|Guided Musical Play||“the teacher serves as a guide to the child’s exploration”
(Flohr and Trevarthen 2008, 87.)
|TTC Subway Song|
|Creative Musical Play||“the child is left alone to explore instruments”
(Flohr and Trevarthen 2008, 87)
|Performing from a graphic score|
|Negative Affect||“uses negative affect to initiate contact, to begin a social interaction with someone else; uses face or voice very expressively to show negative affect”
(Minnesota Preschool Affect Checklist, Denham 2015)
|Expressing sadness or distress|
|Positive Affect||“displays positive affect in any manner-facial, vocal bodily; shows ongoing high enjoyment (30 sec. or more)
(Minnesota Preschool Affect Checklist, Denham 2015)
|Vacant||“displays a flat, unexpressive, detached face; looks emotionally absent”
(Minnesota Preschool Affect Checklist, Denham 2015)
|Lack of any expression|
|Self-regulation||“regulation processes directed mainly to regulate children’s own processes, with no apparent intentions to influence other children’s cognitions, emotions or behaviors. It may include … non-verbal behavior, indicating monitoring or regulation of cognition in order to achieve a personal goal”
(Whitbread 2009, 73)
|Waiting for a turn to be the robin|
|Shared regulation||regulation processes more related to group planning, monitoring and regulation of a joint activity” (Whitbread 2009, 73)||Supporting peers by being a captive audience|
In terms of emotional responses, the children tended to display more positive affect than negative affect in most forms of musical play. The affective responses that were elicited through each category of musical play varied significantly. Interestingly, the welcome and good-bye songs (ritual songs) elicited the least positive responses and the most vacant responses. Alternatively, creative musical play in this diverse community setting elicited the most positive emotions. The guided musical play elicited more positive emotions than the ritual category. It is important to note that the more prescribed the activity, the frequency of displaying positive affect decreased. For example, the ritual songs at the beginning and at the end usually elicited either a vacant or negative display of affect. The least prescribed activity, creative musical play, elicited the most positive emotions of all three categories of musical play. “This is an issue that needs be clarified through continued but perhaps broader investigations on the relationship between the affective domain, musical responses, and diverse populations” (Diaz and Silveira 2014, 75).
There was also a recurring set of social responses elicited by all forms of musical play in the early childhood music classes. In almost every musical play activity, most children were able to self-regulate as well as regulate with others (shared-regulation). Within specific forms of guided musical play, such as ‘Tommy Thumbs Up’, children moved quickly and effortlessly through stages of laughing and singing loudly to stages of sitting quietly, waiting for the next instruction. The most prolonged instances of self and shared regulation occurred in the creative musical play activities. Creative musical play elicited the most positive social behaviors despite the observations of Flohr and Trevarthen (2008) that “of all the music experiences for young children, creative experiences are the most often forgotten in classrooms” (2008, 87). While engaged in creative musical play such as the guided composition activity, the children responded positively to their teacher’s prompts to describe what they were playing. In addition, they readily accepted her efforts to help them to navigate around their graphic scores. At no time did the teacher attempt to “teach” the children how to make music during these sessions. On the contrary, the interactions resembled more of a partnership in creative music making.
It is up to us as teachers to nurture rather than repress the deeply rooted natural musicality that young children inherit and to use our intelligence and creative imagination to foster its healthy growth from those roots. If we do this with humility and dedication, children will grow up in their own world of sound to make inventions that will belong to them and their community and that will be integrated into its social life for the sake of celebration and delight. (Pond 2014, 48)
The analysis of creative musical play that emerged within this diverse community of young learners reveals the potential of this particular form of play to promote children’s social and emotional development. When examining the different forms of creative musical play, there is evidence that psychosocial behaviors such as the ability to be calm, to focus, attend to others, as well as to self-regulate and co-regulate with others were either enhanced or facilitated. Building on Greenspan’s theory, Shankar (2013) proposes the notion that self-regulation and co-regulation contributes significantly to overall psychological well-being (138, 141). In this linguistically and culturally diverse class, creative musical play exemplified the “power of musicality to facilitate and energize meaning in communication”(Malloch and Trevarthen 2009, 6). The vitality and nature of music making in early childhood is revealed in the way musical communication affirms the relationship between self and others. “Children can simultaneously manifest their musicianship as well as their compassionate selves thereby affirming their place in the world community of music makers” (John 2002, 181). This was especially evident when the children were involved in creative musical play.
As this was a ‘bounded’ case study of early childhood classes in one specific community music school over a short period of time, no broad generalizations on music teaching and learning can be made. However, this exploratory case study sheds light on a number of potential benefits of adopting this creativity-focused approach to early childhood music education in an urban community music setting. First, young children from diverse backgrounds were able to express their spontaneous and innate musicality, both individually and collectively through three different forms of musical play, creative musical play being the most effective. This affirms the need to view music “as an extension of sonic discovery and the capacity of sounds to be employed for playful narrative or affective purposes” (Bannan and Woodward 2009, 479–80).
Secondly, the innovative approach adopted by the early childhood teacher inspired musical communication through her design of “‘authentic’ curricula that are meaningful to children” and her awareness that “children’s musicality foster a sense of wonder and fascination that facilitates openness to emergent musical behaviors that may exceed preconceived expectations” (Malloch and Trevarthen 2009, 528). Traditional early childhood music classes that focus on Western Art music curricula tend to rely on a progressive stage mentality that may impede musical communication by requiring children to follow a prescribed pedagogical model. According to Kelly-McHale and Abril (2016), “the reliance on a Western European view can alienate students and, in music class, can contribute to a feeling of musical isolation” (159). Alternatively, the non-verbal musical expressions of the children engaged in the creative musical play category revealed musical communication that could potentially contribute to a sense of community.
Thirdly, while the ability to make music is a universal capacity, the carefully constructed shared musical experiences, informed by Greenspan and Shankar’s (2004) theory on the evolution of symbols and reflective thinking, enable children to not only be aware of each other, but relate to others in a very unique way through creative musical play such as guided composition, free exploration, and spontaneous improvisation. There is a need therefore to examine and validate such non-conventional approaches to music education in light of the intimate connections that may arise between the teachers, young children, and their peers, regardless of their cultural backgrounds. “Through their musical creativity and collective music-making, therefore, children discover identity in relationship with others.” (St. John 2015, 335). The individual experiences of creative musical play often inspired the children to share their discoveries with their peers on their own accord or when facilitated by their teacher. This supports St. John’s (2015) observation, “for children, musical creativity is intimately connected to being and belonging. It is about finding one’s place in the musical community and delighting in the ability to contribute to that collective effort” (334). Finally, students seemed most connected to the actions of music making, expressed the most positive affect, and revealed more self and social regulation when performing their graphic score or when they were free to explore the instruments of their choice. According to Littleton (1998), “the presence, attraction and holding power of musical instruments reveals the young child’s capability for sustained interest in music-making when allowed to freely choose what, how, when, and with whom he or she plays” (13).
While musical experiences are typically culturally grounded, musicality refers to “the expression of all human desire for cultural learning, our innate skill for moving, remembering, and planning in sympathy with others that makes our appreciation and production of an endless variety of dynamic temporal narratives possible” (Malloch and Trevarthen 2009, 4). Creative musical play sets in motion the abilities to signal emotionally, understand the emotional signaling of others, and enables the ability to be self-aware, which is especially significant in an early childhood class comprised of children from diverse linguistic and cultural backgrounds. In addition, it nurtures attentiveness, curiosity, and the ability to understand causality all of which lead to the development of empathy and morality (Greenspan and Shankar 2004). Experimenting with instrumental sounds through creative musical play in a culturally diverse early childhood music class best exemplifies Dissanayake’s (2009) assertion that “communicative musicality helps us to appreciate music’s emotional and transformative power in human experience”(27), compared to all the other forms of musical play.
A young child is able to savor a single sound as a unique experience. He or she can enjoy the godlike ability to make an inert, inarticulate object produce sound. All music, all delight in music, all authentic acts of musical invention are rooted in this seminal musicality—a music appreciation such as no method can circumscribe nor any classroom instruction impart. Here we are irreducibly at the roots, and we had better see to it that what we have learned by rote we do not use to frustrate our children’s unarguable instincts and so alienate them from their own musical beings. (Pond 2014, 48)
Implications for further research
An important implication that requires further study is the relationship between exposure to multiple instruments through creative musical play and the motivation to study an instrument formally upon completing the early childhood music classes. The Regent Park School of Music provides an excellent model, by providing at least two years of early childhood music classes based on innovative approaches, before offering a child private lessons on the instruments of his/her choice. Longitudinal research is needed to determine to what extent exposure to multiple instruments through creative musical play influences success on a chosen musical instrument in later years. Further research is also needed on the benefits of creative musical play on social, emotional, as well as musical development in early childhood music classes in daycares, schools, as well as community music settings.
Creative musical play enables children from diverse cultural backgrounds to choose how they will communicate musically. In urban settings such as the Regent Park School of Music, the effects of such potentially empowering experiences may include enhanced self and shared regulation behaviors, increased bursts of joy, and other positive emotions, thereby nurturing the core capacities to feel and relate to others, both of which constitute key tools of learning that promote psychosocial development and well-being in the early years.
About the Authors
Dr. Bina Ann John is an Assistant Professor and Concurrent Teacher Education Coordinator at the Faculty of Music, University of Toronto. She teaches undergraduate/graduate courses in Child Development in Music Education, Psychological Foundations, Keyboard Skills, Curriculum Inquiry and Music in Childhood. Dr. John received the Faculty of Music Excellence in Teaching Award at the University of Toronto in May 2014. Currently, Dr. John is working on a collaborative project with the Regent Park School of Music to bring music education to vulnerable and at-risk youth in the Greater Toronto Area. Dr. John has presented papers at music education conferences at the University of Exeter, Great Yarmouth, Newcastle, Barcelona, and the International Symposium on the Sociology of Music Education in New Orleans. She will be presenting a paper at ISME 2016 in Glasgow this July. Dr. John is an active sacred music clinician and conducts the St. Gregorios Orthodox Choirs in Toronto.
Dr. Linda Cameron is an Associate Professor with the Department of Curriculum, Teaching, and Learning at OISE. Her research interests focus on early childhood language and literacy, children’s literature, the role of parenting in education, adaptive instruction, teacher education and professional development, interdisciplinary arts education, and the education of young girls. She’s been awarded numerous research grants to explore the impact of early childhood education in the arts and music, and has contributed to OECTA research into the pros and cons of the implementation of full-day kindergarten in Ontario. Dr. Cameron’s professional involvement in early childhood education is rich and varied, including work with the Ministry of Education, the TDSB, the Royal Conservatory of Music, and the CBC.
Dr. Lee Bartel is Professor of Music Education and Music and Health as well as the Associate Director of the Music and Health Research Collaboratory (MaHRC) at the Faculty of Music, University of Toronto. He has special interests in conditions of learning, pedagogic culture, social psychology, and music in human development as well as general educational topics ranging from international education, issues of evaluation, professional development, and homework. He currently has research studies underway in: music enjoyment ability retraining, approaches for cochlear implant recipients, Rhythmic Sensory Stimulation for Cardio Rehab, Fibromyalgia, Major Depression and Alzheimer’s Disease.
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