Music Therapy - A Universal Language

Esther Thane is an expert in music therapy whose team helps families with children who have autism communicate and reach behavioral objectives while exploring the universal language of music.

 

TRANSCRIPT

Evan Kelly  0:04  
So welcome back to DDA's Encouraging Abilities podcast. I'm your host, Evan Kelly. I'm the Communications Manager here at Developmental Disabilities Association. This is where we connect with advocates in the disability community, help tell their stories, raise disability awareness and just be a supporter and advocate for them as well. For those who don't know about us at DDA, we are a community living agency that serves Vancouver and Richmond, we support roughly 2000 clients with developmental disabilities and their families and have been doing so since 1952. So yay, this is our 70th anniversary. We recently came across an article that's actually quite near and dear to my heart. In fact, it's been published a few times over the past couple of years that drum lessons have a positive impact on people with autism. Now, I've been playing drums for over 30 years, so I thought the impact was fantastic. And I just read this on the website disability scoop, so I'm going to read this verbatim from the website about their research, "researchers looked at 36 people with autism between the ages of 16 and 20 with no drumming experience. 19 of them received 45 minute drum lessons twice each week for eight weeks while the rest took no lessons. All of the participants were given a drumming assessment and an MRI scan at the beginning and the end of the study, and their guardians were asked about their behaviour. At the conclusion of the intervention, those who improved their drumming abilities showed a reduction in hyperactivity in attention and repetitive behaviours and they displayed better control of their emotions. According to findings published recently in the journal Proceedings of the National Academy of Sciences. Now that is just drums. So music therapy obviously covers a lot more than just playing drums. So joining us today is Esther Thane who operates ET music therapy in North Vancouver and Richmond, ET music therapy covers a wide range of musical mediums all focused on treating autism and they have been operating since 1996. Esther has been involved in music and music therapy for years and used to teach the Bachelor of Music Therapy Program at Capilano University and has received several awards for her groundbreaking work. So welcome to the podcast.

Esther Thane  2:06  
Thanks so much, Evan. Happy to be here.

Evan Kelly  2:09  
Excellent. So what initially inspired you to work in the field of music therapy?

Esther Thane  2:14  
Oh, gosh, that's a long story. I'm not sure everyone wants to hear it or not? Well, we were very musical family. I mean, my parents are not musical. But it's something that they always pushed my sister and I to do so ever since we were children we were involved in choir, vocal lessons, piano lessons, theory, etc. We were in band, etc. And my sister is a concert pianist. Her and her husband have a piano duo called the Bergman duo here in the Lower Mainland, and I watched my sister as a child, I was younger than her and I watched her practice diligently for four hours a day plus, and thought to myself, that's not what I want to do. However, I realized very early on that music was one of the only things I did know how to do and was good at so at the same time, I didn't want to teach recorder and ukulele in the school. So I thought where do I go from here? Where's the middle ground? And I hadn't heard about music therapy whatsoever. But my parents encouraged me to take a year off of university because I was just, you know, accumulating student loans taking this and that and not knowing what I wanted to do. So I took the year off, and I was living in Germany. My sister at the time was also in Germany, studying music. And at the end of the year, I was supposed to, of course, find myself in that year's time and decide what I wanted to do for a career. But that hadn't really happened. And a few months before I was leaving to come back home, I was going for a walk with my sister and she said, well, what about music therapy? And I just, something inside me went, that sounds good. I had no idea what it was. But I just kind of took a leap of faith and thought that's probably what I want to do. So I did all my prerequisites. I got into the music therapy bachelor program at Capilano. And that first day I remember sitting in class and all of my classmates were telling stories about in the summer time how they volunteered with this music therapist and did this then that. And I still had no clue what music therapy was. But my gut told me this is where I'm supposed to be. So it was really as simple as that, of just, you know, taking that leap of faith that blind faith and as I was going through the program, every week that I progressed in the program, realizing this was, this was my vocation. This was my calling. And the first time I saw a video of kids with autism in music therapy session I thought to myself, and that's the population. That's the community I want to work with. So I've never looked back.

Evan Kelly  5:07  
What does music therapy offer that other therapies don't?

Esther Thane  5:12  
Well, you know, that's a really good question. And I think what I always say is that any child, like when we're just talking about children, because of course, music therapy you can do with adults, you can do in palliative care you can do with brain injury, there's a myriad of different diagnoses and conditions that music therapy can target very eloquently and beautifully. But when we're talking about kids, I always say, you know, a child will integrate new information at a deeper level, new skill sets at a deeper level, if it's coming from a place of inner motivation. So instead of being taught and told what to do to explore and experience it on their own, and they will integrate that new learning differently. So, you know, for me, I think we are really lucky, and we're blessed. And we kind of have this extra thing called music as our partner in therapy that other therapies don't have. Because for most kids, I mean, not all but for the majority of children, and individuals in the world, all adults of all walks of life, music is motivating. Music is something that helps us pass the time, it makes time go faster, you know, I'm a runner, if I don't have my music with me in my earbuds, I can't run a block. But if I have music the time, just you know, that's why we listen to music on long trips, you know, it warps the perception of time. And I think for kids, they come into the music therapy space, feeling like it is more effortless that they're just having a good time. And they have no idea that we're targeting all of these sensory systems and primary systems simultaneously, just by making active music. 

Evan Kelly  7:00  
So it's just you taking it from the point of view that this is fun. This is fun. Yeah. I mean, as musicians, you and me both can attest to that. 

Esther Thane  7:08  
Yeah, you know, otherwise, we wouldn't be doing it, right? 

Evan Kelly  7:10  
Exactly. Yeah. Now, have you always only just primarily sort of worked with autistic children? Or have you worked with adults? Other neurodiversity? Or PTSD or anything like that?

Esther Thane  7:23  
Personally, I would say my wheelhouse is developmental delays in general, all diverse needs from autism to ADHD, Down syndrome, anxiety, some depression, any different developmental conditions, and of course, have worked all the way from, you know, two year olds, to adults, so yeah.

Evan Kelly  7:46  
Wow, that's good. Now, your website says this is quoting your website, children with ASD seem to enjoy musical experiences, because they're often good at it. Can you expand on that?

Esther Thane  7:57  
Yeah, I mean, I, that is a little bit of a blanket statement. And I don't want to generalize with that statement. However, really, in my experience, that's what I've seen, they are good at it. And what I mean by that is, there is a special relationship with autistic kids and music. It's a medium that they often prefer to live within. They have often more sophisticated musical tastes. They have incredible memory recall, you know, I had one client come in, and we were just improvising the whole session. And a whole week went by, I'd seen multiple other clients in the meantime. And when he came back through the door, he remembered the exact music motif from our improvisations a week prior, I couldn't remember because I had had many different improvisations with lots of other clients in the interim. But they can hear something, they can memorize it, they have unbelievable appreciation often for even just chord progressions and chord structures. And, you know, for me, I was so spoiled by that, that element within their personalities, because I've worked with hundreds of kids with autism before I had my own children. And then when my own children came along, I was like, perplexed, why, why aren't you so excited about music because, you know, as a musician, I am very excited about music, and it's my passion. And it's, it's what really gets me from within, you know, and I was always able to share that joy and that passion with the kids that I was working with, and, you know, my kids, they love music, too, but, you know, they can kind of take it or leave it. They weren't as like, they didn't get the, you know, the goosebumps like I do when I hear certain chord progressions, and you know, and so I think I was really spoiled all those years with with working with them and, and I think that's something that we share on a on a real visceral level.

Evan Kelly  10:04  
Yeah, I mean, as you know, again, as a musician, I feel lucky that we sort of connect with music on those levels, and then sort of go and play it and have fun with it. Now, music obviously can be very structured in a lot of ways. If it's sort of written down and written there, there's a song you're supposed to play in a certain way, a certain tempo, a certain loudness. But you've also mentioned improvisation. And it seems to me that kids with autism, appreciate that structuredness. But how does improvisation work?

Esther Thane  10:36  
Well, you know, it really goes on a case by case basis, you know, when when a kid comes through the door, we're really assessing informally, what do they gravitate towards? What types of instruments, what genres of music, what kind of musical experiences do they gravitate towards, you know, some kids really like structured music activities, where we're really addressing auditory discrimination and temporal skills, and temporal pacing, and self regulation through the music and other kids just walked through the door, and all they want to do is improvise. So when we're improvising, we're having a conversation. And I think for autistic kids, often, they love music, because it's a non threatening language. And whether you are verbal or nonverbal, we can all communicate through the music. So if a child is saying something, by playing three notes on the piano, the music therapist can take those three notes, they can shadow those three notes and create a whole music motif and structure around that. So we're letting that child know I hear you, in whatever you're doing, if you hit the drum once, we're gonna hit the drum and accompany you, and just play when you're playing and match you. And so in that way, you can have a call and response conversation back and forth. That doesn't require words, it's really the skills of the music therapist intuiting what that child is trying to say, through the music, what their emotive expression is in that moment and matching the intensity. So it's not just about matching the notes, but it's matching the intensity or the intent that we're perceiving behind what that child is giving musically.

Evan Kelly  12:36  
Now, you mentioned nonverbal, I assume you work with some nonverbal clients as well. Do you find that music helps them open themselves up a bit? 

Esther Thane  12:47  
Oh, absolutely. You know, we can just start out with vocalizing even if we're nonverbal, and we don't have the ability to form language, it doesn't matter in music, right. And we can take a microphone and an amp and we can just vocalize and we can match the client's vocalizations and create again, music around whatever it is that they're vocalizing. If it's a simple hum or grunt or just an ahh or an eee sound. They are it it kind of opens up this whole channel of expression that doesn't require language.

Evan Kelly  13:23  
So it'll be almost be anything it needs to be or anything it wants to be. 

Esther Thane  13:26  
 Absolutely, you've got it. Yeah.

Evan Kelly  13:29  
That's amazing. Now, how much of your practice is based on vocal therapy and how much is on actual instrumentation?

Esther Thane  13:36  
You know, I would say it's pretty half and half, the therapists, we have it ET music therapy, they use their voice acapella all the time. They use the voice as a primary instrument, but they also use the piano and the guitar. So yeah, it's almost like, I would say almost a third, if you know, actually, it's a third guitar, third piano third voice, but it's always intermixing and changing, you know, the dynamic changes. Depending on each child, you know, some children don't want you to use your voice and they, they don't want to hear you sing, they just want to hear themselves sing. And, you know, some kids are more instrumental based. So again, it's a real, a real case by case basis.

Evan Kelly  14:21  
Do you find, I mean are there benefits to either or do they sort of have similar outcomes in what you're after?

Esther Thane  14:29  
Well, you know, it depends. If the child, if one of the target goals is language acquisition, then of course, we're going to use more oral motor vocalizations. We're going to use the kazoo to use that as an outlet for expression to explore the voice and making sounds. You know, that whole pre verbal level first, but certainly expression can be absolutely just through instrumentation. You know, we have a lot of kiddos that come in the door and you can tell from the get go. And you probably are the same way as a drummer for so many years, you can you can pinpoint who's the rhythmic guy in the room, right? They come in and they're tapping on the walls already, they're tapping on the doors, and they just need to get things out rhythmically. And especially if a child is having a really frustrating day. And I think everybody can relate to that, having that outlet, that cathartic outlet to just wail on the drums, you know, and feel heard and know that that is an quote unquote, appropriate way to get any anger out, or any frustration that you have, by you know, wailing on a conga drum or something or djembe, where it's going to be heard, and it's going to be accepted by the therapist in the room. And, and we feel better after.

Evan Kelly  15:49  
I can attest that that is an appropriate way to get rid of some emotion and energy. Absolutely. In terms of like instrumentation and vocalization is all you know, obviously a part of that. Do you try and teach them musical theory? Or like, Hey, have you heard of this guy? It's Rachmaninoff? Or it's, it's Rush?

Esther Thane  16:13  
Yeah, well, you know, I mean, great comparison, all the way from Rachmaninoff to Rush, absolutely. And anywhere in between, you know, somewhere there's a book in there, Rachmaninoff to Rush. That's a great book title. Again, it really depends on where the interests are for the child and kind of a main foundational principle of music therapy, not dependent on you know, any type of person you're working with is that music therapy is going to be way more effective if you are using the client's preferred music. So whether or not you like country music, if the client likes country music, you gotta go there. You know, if they like classical music, then you're gonna go there. And we find that, you know, in general changes can be made in the brain based on music preference. There was a study, I don't know, quite a few years ago with Oliver Sacks. And you know, Oliver Sacks was always a real advocate of music therapy. And, you know, he wrote that that book musicophilia. And there was this one YouTube that I was watching that he did, where he was getting an MRI of, you know, when he was listening to certain music, and it was very well known that he preferred Bach to Beethoven. And what they did was they, I can't remember what university he was at. Well, I won't, I won't try to say what I can't remember, anyway. But what they did was they found a piece of Bach music that he had never heard before. And before that, they played Bach. And they played Beethoven. And they could see that the activity in his brain was less when they played Beethoven. And then they played a Bach piece that was just kind of later on in Bach's compositions. So it was kind of the end, almost nearing the end of the Baroque period, he was kind of touching on some classical and romantic, you know, essences of Beethoven. So he wasn't sure himself if it was Bach or Beethoven. But his brain scans showed it, that he was more lit up listening to the music. So I think his premise at the end of this experiment was that, I may not know or I think I know what I like, but my brain actually knows what I like, and responds more. So I think that's a really key principle, is that where that child wants to go to if they like reggae, if they like pop music, if they like alternative, or Rush or classical. That's where we really start the therapy from, we're always going to use what motivates the child because again, if it's coming from that place of inner motivation, it's effortless. And, you know, I don't like country music. So I'm not going to be receptive if you're playing country music for me.

Evan Kelly  19:12  
Maybe some Keith Urban. 

Esther Thane  19:15  
Maybe, maybe, yeah, you know, but it's, it's really what is invoking this kind of interest and curiosity, and it really is dependent on where they, what they like, and what they're humming. And, you know, that's one of the first things we do when I'm talking to parents at the beginning. Before you know, just for the intake information is I asked, you know, what kind of music does your child listen to? What are they gravitating towards? What are they dancing to, you know, whether it's a theme song from a kid show or something they found on YouTube or if they like Metallica, then we prepare our therapists. That's what they're going to do in that first session. So that becomes that icebreaker and bridging the gap you know, so we're establishing rapport with that child using the music that they love. Because then they feel heard and understand, understood, you know? 

Evan Kelly  20:07  
Now, does that mean you've got to hire people that can play Metallica or Rush? Workout some riffs here for you?

Esther Thane  20:14  
Yeah, well, you know, I think a lot of the music therapist life, from a day to day basis is learning different types and styles of music based on their clients. So you know, you whether you like it or not, you kind of have to, because we have to go there so that we're meeting that person where they want to be met in the music. And that's, you know, my curriculum that I created is called meet in the music. And that's, you know, as the name says, it's really about meeting that person in the music and going on this journey together.

Evan Kelly  20:48  
Now, like in terms of the instruments, I mean according to the article that I've sort of inspired me to talk to you about this stuff, drums work well, what other instruments do you find work well? Is it sort of whatever? Again, a case by case basis, I would assume, yeah. But uh, you do find that there are other certain instruments that work better and helping the child progress?

Esther Thane  21:08  
A great question. And again, you know, there's no magic formula to that it's each child, you know, is is their own case, we try to have at both of our Music Therapy Studios a whole myriad of different instruments for the child to explore from electric guitars, to electric basses, drum kits, we've got a harpsichord in our Richmond studio, we've got pianos, we've got a harp, we've got in our North Van studio, we have a big four foot long tone drum like a slick drum that has lots of different tones. And we can turn the drum over on the side and the child can lie on top of the drum and the therapist is playing on the side of the drum. And they're getting all of this deep vibrational input, which really helps with self regulation, it helps calm their systems down, and it brings them to an appropriate arousal level, so to speak. 

Evan Kelly  22:07  
And that sort of brings me to the parents aspect of this, do you find that the clients that come to you, are they... Are they just using the music program in addition to other therapies? Or are they sometimes coming to you because they've exhausted other therapies?

Esther Thane  22:25  
Both. Yeah, absolutely. You know, the music therapist is enhancing all of the other goals that the rest of the treatment team has. So you know, if a speech therapist is working on language acquisition and wants to work on ideation of thought, and for the child to formulate their own sentences, and have conversations, we do that in the music. We'll sing different things to each other, will sing questions and answers to each other. You know, an occupational therapist might be working on motor practice and gross and fine motor skills. Well, naturally, we do that, I mean, when you're playing an instrument, when you're striking a drum with a mallet, you're working on eye hand coordination, you're working on mallet grasp. If you're playing an instrument, like small percussion instruments, where like a triangle, for instance, everybody knows what a triangle is, and you know, you're holding the triangle with one hand, and you're holding a mallet with the other. So you're doing two different things with two sides of your body. So I think naturally, we're always targeting multiple goals simultaneously.

Evan Kelly  23:31  
Now, how soon after starting music therapy, do you notice changes in your clients?

Esther Thane  23:37  
Again, that can really vary. I mean, you know, a lot of parents will say to me on the phone, well, you know, my child doesn't attend, doesn't have a high attention span can maybe only tolerate a half hour, you know, in any activity. And I'll say, well, let's just, let's just give, you know, let's just wait and see how it is in music. Because again, that perception of time, it's evasive, it just, it's gone when you're actively making music. So, you know, for some kids, they come out, you know, the withdrawn kid just comes out and starts to blossom and express themselves in different ways. Because it's a different outlet than when we, the rest of what we see in society where we're just kind of walking and talking and having to act a certain way. And in music, we can express ourselves creatively, some kids, you know, they progress in different ways. You know, I've had clients that have been very anxiety ridden, very disregulated. And all they do is scream for the first you know, couple of sessions or even months or it's hard to get some kids even to come into the space to go over that threshold of the front door and go into an unknown environment. But then they don't want to leave you know, so it really depends, you know, some kids start vocalizing and saying words for the first time, after a few sessions, some kids, you know, it'll take longer, but they're also very highly motivated to come back. Because again, they're building this relationship with the therapist in a different way where it's not, you know, sit down table work here, we've got to go through these exercises, etc. And, you know, kind of coming back to one of your original questions about do we teach theory or music, that's often a natural progression that will be incorporated in the session. So, you know, some, some kids are with us for many, many years. And after they've kind of gone through the traditional music therapy route of different activities and improvisation. As they grow up, it kind of naturally evolves into music lessons, but it's more adapted music lessons, where, you know, the therapist is very knowledgeable of, you know, what things are going to trigger the person, if they have any auditory defensiveness, you know, do they need frequent breaks, because they need to do some spinning or movement, or stimming of some kind, you know, we have that flexibility as music therapist, so an adapted music lesson looks quite different than a traditional music lesson.

Evan Kelly  26:23  
Now, do you find that they're permanent changes in emotional control under behaviour through music therapy? Or is this something that you find things to keep going for a longer period of time?

Esther Thane  26:33  
No, you know, I think that because again, I know I keep kind of coming back to this same point, because they are motivated from within, because there is a natural curiosity to explore music, a child's attention span can naturally just be extended, right? We know that a child when they're interested in something, and they're focused, they can focus for hours, right? If it's something that intrigues them, and so the more often you're doing this, the more that's going to generalize and carry over into when they walk out the door. And they're going to be able to regulate for longer periods as well. You know, and we always encourage parents, you know, to do different things at home and use music, in day to day tasks, anything that's going to make it more fun, whatever it is that the child doesn't, you know, warm up to immediately you can add this whole level of music to it. And, you know, it's just, I don't know why I just thought of this, but thinking about, you know, Mary Poppins, when they were cleaning the room, and she started singing, you know, a teaspoon of sugar makes the medicine go down, right, and singing that song, all of a sudden, the task of cleaning the room was easier. You know. So I think it's marrying music with things also that are not preferred tasks to do, kind of alleviate any anxiety around it, or stress and make it a more fun experience. You know, there's, there's a reason why in every single culture in the world, throughout the history of mankind, there's music, you know, I think the oldest instrument is a flute, they found 30,000 years ago, you know, there's something inherent inside human beings that we want to express musically. We have rituals, in our cultures, there's no culture that doesn't have music, be integral, we always have found time, even if we're chasing, being chased by dinosaurs, or well, okay, whoever, you know, we feel this need to express through art in general. And, and so I think that is something that's universal. So that's why music therapists could work with a child who comes from an entirely different country and speaks a different language. And they can still build a relationship through music. It's a whole language of its own. And there aren't a lot of activities in the world that you can do that.

Evan Kelly  29:01  
No, there definitely isn't. Now, what ongoing work in your field right now has you the most excited?

Esther Thane  29:10  
Gosh, I would say, what makes me the most excited is bringing it to everyone else in the world to realize that, you know, yes, there's the profession called music therapy. And yes, people go to school for it and get lots of training and medical and psychology and therapy and blah, blah, blah, blah. But what excites me is, creating this, this level of awareness that people realize they can be doing this, they can do a level of music therapy for themselves, they can do that at home, that we don't own the therapeutic benefits of music. And you know, I think that a lot of that has been lost in our culture. You know, we pay money to go to concerts and sit quietly and listen to music. You know, we don't make music anymore. In the household, you know, 100 years ago, there was always a piano or a violin or accordion somebody in the family did that. And after supper, that's what you did. You sat around and you made music. That was your MTV that was I mean, even that's dating us, a little bit, of but that was our technology that was our devices, you know, was making your own music and expressing that. And I think, you know, for parents to get back into that to feel confident that they can use their voices with their children that you can vocalize and sing and, you know, we get shut down at a very early age, often in music education, by being told by teachers, especially if you were in a choir, I'm sure there's people out there that can relate to this experience at a young age, if you're in a choir, and the teacher said, just lip sync, right? You're tone deaf or you're not singing the right. So just pretend that you're singing, and those old truths, they stay with us throughout our entire lives. And then we have our own kids. And we're convinced Oh, I don't have a good voice. I can't sing around my children. But we're forgetting that the voice is the first way that your child connected with you, whether you're a father or a mother, you know, the, the auditory system is the first sensory system that's fully developed or gets developed at four months gestation. So that child has been listening to the mother's voice inside in utero, all the time, they are hearing the father's voice through the womb for many months before they come out. So when you speak, when you sing, you know, chances are that's the most beautiful sound your child has ever heard. Because that's what is familiar with them. And so that should keep going, you know, and, and being able to just free yourself of any sort of criticisms of your voice, you know?

Evan Kelly  32:01  
I could see that being pretty daunting for parents, because I know lots of friends and fellow parents who are like, Oh, I haven't got a talented bone in my body. The idea of, you know, offering music to my kids isn't difficult for me. I'm not a great singer. But they know, I play drums and I can, they know, I still play music in a band. So they know that element is there in their life. And as much as I'm trying to push it onto them, yeah, forget it. They're not interested. Yeah. But it's there, you know, and we, my partner, or I, our partner and I are always playing music in the house. So we're always trying to make sure that that's there. Now. ET music therapy already has quite a big team. How do you see your company changing in the next decade?

Esther Thane  32:41  
Well, you know, I think we're always expanding, we just hired two new music therapists and, you know, we've got the two studio locations. I foresee in the future, you know, that maybe we're going to expand to another studio location, you know, right now we kind of serve the whole lower mainland and depending on where you're situated, where it's closer to, you know, where's easier to go to, is it Richmond, our Richmond studio or North Vancouver studio. So we have a lot of clients that are in the Vancouver area, but travel to us because we are open seven days a week in both studio locations. So, you know, that makes a little easier for parents to travel on the weekends. But certainly expanding, growing, getting a new site, maybe, you know, all of our therapists are using, as I mentioned before, the curriculum that I've created meet in the music, and it's on a cloud software therapy and documentation software called Unitas TI. And there are music therapists now that subscribe all around the world that are using that curriculum with their clients in Australia, in the US and across Canada. So just you know, helping to spread the word and get music out there to the massesm, really.

Evan Kelly  33:56  
We're doing what we can. Now, do do clients need ta referral? Or can they just approach you for services?

Esther Thane  34:03  
They can just approach us, no referral is necessary whatsoever. On our website, there's a Contact Us form, and they can just fill it out. And then I usually have a nice chit chat with them on the phone and get to know who their child is, you know, what their preferences are, their challenges, their strengths. And then we try to see if we can fit them with a good music therapist and a good time that you know, they can come for weekly music therapy.

Evan Kelly  34:31  
That sounds really good. How do people get in contact with you?

Esther Thane  34:33  
They can go to the website. It's www.etmusictherapy.com

Evan Kelly  34:41  
Well, that's fantastic. That about does it. We have been speaking with Esther Thane and she is the creator of ET music therapy. That's a music therapy organization that caters to families and children with autism. They've been around for how long you've been around for about?

Esther Thane  34:57  
26, we're on our 26th year yeah. Absolutely.

Evan Kelly  35:01  
You're going strong and in North Vancouver and Richmond, correct?

Esther Thane  35:04  
Correct, correct. And we see all diverse needs. You know, certainly our specialization is autism. But we see all different, all different walks of life.

Evan Kelly  35:16  
Thank you very much for joining us today.

Esther Thane  35:17  
 Thank you.