Music therapy for autistic people

Rhythm and music for promoting sensorimotor organization in autism: broader implications for outcomes

Emerging research suggests that music and rhythm-based interventions offer promising avenues for facilitating functional outcomes for autistic individuals. Evidence suggests that many individuals with ASD have music processing and production abilities similar to those of neurotypical peers. These individual strengths in music processing and production may be used within music therapy with a competence-based treatment approach. We provide an updated perspective of how music and rhythm-based interventions promote sensory and motor regulation, and how rhythm and music may then impact motor, social, and communicative skills. We discuss how music can engage and motivate individuals, and can be used intentionally to promote skill acquisition through both structured and flexible therapeutic applications. Overall, we illustrate the potential of music and rhythm as valuable tools in addressing skill development in individuals on the autism spectrum.

Emerging Treatments and Therapies for Autism Spectrum Disorder: A Narrative Review

The prevalence of autism spectrum disorder (ASD) has increased over the last decade. In this regard, many emerging therapies have been described as ASD therapies. Although ASD does not have a cure, there are several management options available that can help reduce symptom severity. ASD is highly variable and, therefore, standard treatment protocols and studies are challenging to perform. Many of these therapies also address comorbidities for which patients with ASD have an increased risk. These concurrent diagnoses can include psychiatric and neurological disorders, including attention deficit and hyperactivity disorder, anxiety disorders, and epilepsy, as well as gastrointestinal symptoms such as chronic constipation and diarrhea. Both the extensive list of ASD-associated disorders and adverse effects from commonly prescribed medications for patients with ASD can impact presenting symptomatology. It is important to keep these potential interactions in mind when considering additional drug treatments or complementary therapies. This review addresses current literature involving novel pharmacological treatments such as oxytocin, bumetanide, acetylcholinesterase inhibitors, and memantine. It also discusses additional therapies such as diet intervention, acupuncture, music therapy, melatonin, and the use of technology to aid education. Notably, several of these therapies require more long-term research to determine efficacy in specific ASD groups within this patient population.

The clinical effects of Orff music therapy on children with autism spectrum disorder: a comprehensive evaluation

Objective

This study aimed to investigate the clinical effects of Orff music therapy on children with Autism Spectrum Disorder (ASD) from the perspectives of parents, evaluators, and therapists.

Methods

93 children with ASD aged 3-6 years participated in the study. They were divided into an observation group (n = 48) receiving comprehensive rehabilitation intervention including Orff music therapy, and a control group (n = 45) receiving only comprehensive rehabilitation intervention. The Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Psycho-educational Profile-3rd edition (PEP-3) were used for assessments before and after the intervention.

Results

There were no significant demographic differences between the two groups. Both groups showed significant improvements in Sensory, Relating, Language, CVP, EL, RL, VMI, AE, SR, and CARS scores at T1, T2, and T3 (T1 vs. T2, T2 vs. T3, T1 vs. T3) (all p < 0.05). The observation group demonstrated significant changes in Body and Object use and FM, while the control group showed some changes in these domains. Social and self-help, GM, CMB, and CVB also significantly improved in both groups after 6 months of intervention (all p < 0.05). In terms of different time intervals, the observation group showed greater improvements in Sensory, Relating, Language, CARS scores, EL, RL, and SR compared to the control group (all p < 0.05). The improvement levels in Body and Object use, CVP, FM, VMI, and AE did not differ significantly between the two groups in the T1-T2 interval, but were significantly higher in the observation group in the T2-T3 and T1-T3 intervals (all p < 0.05). The magnitude of changes in Social and self-help, GM, CMB, and CVB did not differ significantly between the groups.

Conclusion

Orff music therapy showed significant improvements in language expression, language comprehension, social skills, cognitive abilities, imitation abilities, emotional expression and fine motor in children with ASD. These findings provide support for the use of Orff music therapy as an effective intervention for children with ASD.

The effect of music therapy on language communication and social skills in children with autism spectrum disorder: a systematic review and meta-analysis

Background

Studies have shown that music therapy can be used as a therapeutic aid for clinical disorders. To evaluate the effects of music therapy (MT) on language communication and social skills in children with autism spectrum disorder (ASD), a meta-analysis was performed on eligible studies in this field.

Methods

A systematic search was conducted in eight databases: PubMed, Embase, Web of Science, Cochrane Library databases, the China National Knowledge Infrastructure (CNKI), Wanfang Data, the Chinese Biomedical Literature (CBM) Database, and the VIP Chinese Science and Technology Periodicals Database. The standard mean difference (SMD) values were used to evaluate outcomes, and the pooled proportions and SMD with their 95% confidence intervals (CIs) were also calculated.

Results

Eighteen randomized controlled trial (RCT) studies were included, with a total of 1,457 children with ASD. This meta-analysis revealed that music therapy improved their language communication [SMD = -1.20; 95%CI -1.45, -0.94; χ2 (17) = 84.17, I2 = 80%, p < 0.001] and social skills [SMD = -1. 13; 95%CI -1.49, -0.78; χ2 (17) = 162.53, I2 = 90%, p < 0.001]. In addition, behavior [SMD = -1.92; 94%CI -2.56, -1.28; χ2 (13) = 235.08, I2 = 95%, p < 0.001], sensory perception [SMD = -1.62; 95%CI -2.17, -1.08; χ2 (16) = 303.80, I2 = 95%, p < 0.001], self-help [SMD = -2. 14; 95%CI -3.17, -1.10; χ2 (6) = 173.07, I2 = 97%, p < 0.001] were all improved.

Conclusion

Music therapy has a positive effect on the improvement of symptoms in children with ASD.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/.

2023 clinical practice guidelines on autism spectrum disorder in children and adolescents in Singapore

Introduction

Autism is a neurodevelopmental condition that is increasing in prevalence worldwide. There has been an exponential increase in autism-related research since 2010, when the first Singapore Clinical Practice Guidelines (CPG) on autism was published. Understanding of autism has since evolved to adopt a lifespan approach beyond that of a childhood condition. The aim of this CPG was to provide an updated set of recommendations for children and adolescents to aid clinical practice for professionals.

Method

A multidisciplinary workgroup that comprised representatives from various sectors worked on this CPG. Clinical questions were organised into 10 different sections, each with its own subgroup of members. Seventeen existing international guidelines were evaluated using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) framework, of which 4 met criteria to act as references. Literature review across multiple databases was conducted between January 2011 to 2023; Grading of Recommendations, Assessment, Development and Evaluation (GRADE-like) methodology was used to synthesise evidence. Recommendation statements were derived, following Delphi-style consensus surveys among the workgroup. The draft guidelines underwent external review and public consultation before being formalised.

Results

Recommendation and good practice statements pertaining to care of children and adolescents on the autism spectrum across 10 different sections were developed. Evidence matrices complement these recommendations and detail relevant evidence behind each recommendation statement.

Conclusion

It is intended for these guidelines to promote effective management and healthcare services for children and adolescents on the autism spectrum, by reinforcing good and evidence-based clinical practice within our national context.

Musical Beat Perception Skills of Autistic and Neurotypical Children

Many autistic children show musical interests and good musical skills including pitch and melodic memory. Autistic children may also perceive temporal regularities in music such as the primary beat underlying the rhythmic structure of music given some work showing preserved rhythm processing in the context of basic, nonverbal auditory stimuli. The temporal regularity and prediction of musical beats can potentially serve as an excellent framework for building skills in non-musical areas of growth for autistic children. We examine if autistic children are perceptually sensitive to the primary beat of music by comparing the musical beat perception skills of autistic and neurotypical children. Twenty-three autistic children and 23 neurotypical children aged 6-13 years with no group differences in chronological age and verbal and nonverbal mental ages completed a musical beat perception task where they identified whether beeps superimposed on musical excerpts were on or off the musical beat. Overall task performance was above the theoretical chance threshold of 50% but not the statistical chance threshold of 70% across groups. On-beat (versus off-beat) accuracy was higher for the autistic group but not the neurotypical group. The autistic group was just as accurate at detecting beat alignments (on-beat) but less precise at detecting beat misalignments (off-beat) compared to the neurotypical group. Perceptual sensitivity to beat alignments provides support for spared music processing among autistic children and informs on the accessibility of using musical beats and rhythm for cultivating related skills and behaviours (e.g., language and motor abilities).

Using music to assist language learning in autistic children with minimal verbal language: The MAP feasibility RCT

LAY ABSTRACT

Research has shown that autistic individuals often have unusually good musical skills and that combining words and music helps autistic individuals to focus on spoken words. This study tests the idea that music will help with early language learning of preschool autistic children. The results show that when caregivers sing words to autistic children, the children pay more attention to the caregiver than when the words are spoken and that they learn word combinations more easily.

An Individual Music Intervention for Adults With Intellectual Disabilities and Challenging Behavior: Protocol for a Randomized Controlled Trial

BACKGROUND

Individuals with intellectual disabilities (ID) are more likely to have problems with executive functioning (EF) and challenging behavior (CB), which are negatively linked to well-being. Among clinical populations, music interventions have been shown to improve various outcome measures, such as CB and EF. Until now, no randomized controlled trials (RCTs) have been conducted to examine the effectiveness of an individual music intervention for adults with ID and CB.

OBJECTIVE

The study aims to identify the effect and feasibility of an individual music intervention compared with care-as-usual for people with ID and CB.

METHODS

In this study, a 2-group RCT with a pretest, posttest, and follow-up assessment after 8 weeks is presented. Participants of the music intervention condition will receive 16 individual music sessions within 8 to 10 weeks. The music intervention will be guided by a manual for music workers, in which every session will have a different focus (introduction, emotions, different EF, and end performance). Participants receiving care as usual will function as a control group. After the research is finished, they will be offered a budget, which they can spend on musical activities or musical instruments as they wish. Assessments will include caregiver rating scales and self-report questionnaires and tests, which will assess outcome measures of CB, well-being, depression, anxiety, self-esteem, and 4 domains of EF. A process evaluation will be conducted after the completion of the study, which entails the analysis of data on multiple aspects of the intervention and the study overall.

RESULTS

Enrollment commenced in July 2021, and data collection ended in May 2023. A total of 97 participants were recruited, with 44 participants allocated to the intervention group and 53 allocated to the control group. Data will be analyzed after this protocol has been accepted for publication.

CONCLUSIONS

Because there are currently no published RCTs of an individual music intervention for adults with ID and CB, this study will provide insight into the effectiveness and experiences of an individual music intervention for this target group.

TRIAL REGISTRATION

International Clinical Trials Registry Platform NL8482; http://tinyurl.com/4565s5pd.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52497.

Social interaction links active musical rhythm engagement and expressive communication in autistic toddlers

Rhythm is implicated in both social and linguistic development. Rhythm perception and production skills are also key vulnerabilities in neurodevelopmental disorders such as autism which impact social communication. However, direct links between musical rhythm engagement and expressive communication in autism is not clearly evident. This absence of a direct connection between rhythm and expressive communication indicates that the mechanism of action between rhythm and expressive communication may recruit other cognitive or developmental factors. We hypothesized that social interactions, including general interpersonal relationships and interactive music-making involving children and caregivers, were a significant such factor, particularly in autism. To test this, we collected data from parents of autistic and nonautistic children 14-36 months of age, including parent reports of their children's rhythmic musical engagement, general social skills, parent-child musical interactions, and expressive communication skills. Path analysis revealed a system of independent, indirect pathways from rhythmic musical engagement to expressive communication via social skills and parent-child musical interactions in autistic toddlers. Such a system implies both that social and musical interactions represent crucial links between rhythm and language and that different kinds of social interactions play parallel, independent roles linking rhythmic musical engagement with expressive communication skills.

Biological principles for music and mental health

Efforts to integrate music into healthcare systems and wellness practices are accelerating but the biological foundations supporting these initiatives remain underappreciated. As a result, music-based interventions are often sidelined in medicine. Here, I bring together advances in music research from neuroscience, psychology, and psychiatry to bridge music's specific foundations in human biology with its specific therapeutic applications. The framework I propose organizes the neurophysiological effects of music around four core elements of human musicality: tonality, rhythm, reward, and sociality. For each, I review key concepts, biological bases, and evidence of clinical benefits. Within this framework, I outline a strategy to increase music's impact on health based on standardizing treatments and their alignment with individual differences in responsivity to these musical elements. I propose that an integrated biological understanding of human musicality-describing each element's functional origins, development, phylogeny, and neural bases-is critical to advancing rational applications of music in mental health and wellness.

Music for autism: a protocol for an international randomized crossover trial on music therapy for children with autism

The notion of a connection between autism and music is as old as the first reported cases of autism, and music has been used as a therapeutic tool for many decades. Music therapy holds promise as an intervention for individuals with autism, harnessing their strengths in music processing to enhance communication and expression. While previous randomized controlled trials have demonstrated positive outcomes in terms of global improvement and quality of life, their reliance on psychological outcomes restricts our understanding of underlying mechanisms. This paper introduces the protocol for the Music for Autism study, a randomized crossover trial designed to investigate the effects of a 12-week music therapy intervention on a range of psychometric, neuroimaging, and biological outcomes in school-aged children with autism. The protocol builds upon previous research and aims to both replicate and expand upon findings that demonstrated improvements in social communication and functional brain connectivity following a music intervention. The primary objective of this trial is to determine whether music therapy leads to improvements in social communication and functional brain connectivity as compared to play-based therapy. In addition, secondary aims include exploring various relevant psychometric, neuroimaging, and biological outcomes. To achieve these objectives, we will enroll 80 participants aged 6-12 years in this international, assessor-blinded, crossover randomized controlled trial. Each participant will be randomly assigned to receive either music therapy or play-based therapy for a period of 12 weeks, followed by a 12-week washout period, after which they will receive the alternate intervention. Assessments will be conducted four times, before and after each intervention period. The protocol of the Music for Autism trial provides a comprehensive framework for studying the effects of music therapy on a range of multidimensional outcomes in children with autism. The findings from this trial have the potential to contribute to the development of evidence-based interventions that leverage strengths in music processing to address the complex challenges faced by individuals with autism. Clinical Trial Registration: Clinicaltrials.gov identifier NCT04936048.

Dance movement therapy for dementia

BACKGROUND

Dementia is a syndrome of acquired cognitive impairment which is severe enough to interfere with independent living. Over the course of the illness, people with dementia also experience changes in emotions, behaviour and social relationships. According to Alzheimer's Disease International, dementia affects approximately 55 million people worldwide. The latest NICE guideline for dementia highlights the value of diverse treatment options for the different stages and symptoms of dementia, including non-pharmacological treatments. Relevant literature also argues for the value of interventions that acknowledge the complexity of the condition and address the person as a whole, including their physical, emotional, social and cognitive processes. A growing literature highlights the capacity of the arts and has embodied practices to address this complexity. Dance movement therapy (DMT) is an embodied psychological intervention that can address complexity and thus may be useful for people with dementia, but its effectiveness remains unclear.

OBJECTIVES

To assess the effects of dance movement therapy on behavioural, social, cognitive and emotional symptoms of people with dementia in comparison to no treatment, standard care or any other treatment. Also, to compare different forms of dance movement therapy (e.g. Laban-based dance movement therapy, Chacian dance movement therapy or Authentic Movement) SEARCH METHODS: We searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov and the World Health Organization's meta-register of the International Clinical Trials Registry Portal until 8 December 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that included people with dementia, of any age and in any setting. The DMT intervention had to be delivered by a dance movement therapy practitioner who (i) had received formal training (ii) was a dance movement therapist in training or (iii) was otherwise recognised as a dance movement therapist in the country in which the study was conducted.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies for inclusion, extracted data and evaluated methodological quality. We expressed effect estimates using the mean difference (MD) between intervention groups and presented associated confidence intervals (CIs). We used GRADE methods to rate our certainty in the results.

MAIN RESULTS

We found only one study eligible for inclusion in this review. This was a 3-arm parallel-group RCT conducted in Hong Kong involving 204 adults with mild neurocognitive disorder or dementia. The study examined the effects of short-term (12 weeks) group DMT in comparison with exercise and a waiting-list control group immediately post-intervention and three and nine months later. We found that, at the end of the intervention, DMT may result in little to no difference in neuropsychiatric symptoms assessed with the 12-item Neuropsychiatric Inventory when compared with waiting list (MD 0.3, 95% CI -0.96 to 1.56; low-certainty evidence) or exercise (MD -0.30, 95% CI -1.83 to 1.23; low-certainty evidence). Nor was there any evidence of effects at later time points. Cognitive functioning was assessed with a variety of instruments and there were no statistically significant between-group differences (low-certainty evidence). When compared to exercise or waiting list, DMT may result in little to no difference in cognitive function immediately after the intervention or at follow-up. In comparison to waiting list, DMT may result in a slight reduction in depression assessed with the 4-item Geriatric Depression Scale at the end of therapy (MD -0.60, 95% CI -0.96 to -0.24; low-certainty evidence). This slight positive effect of DMT on depression scores was sustained at three and nine months after the completion of the intervention. DMT may also reduce depression slightly in comparison with exercise at the end of therapy (MD -0.40, 95% CI -0.76 to -0.04, low-certainty evidence), an effect also sustained at three and nine months. Our fourth primary outcome, quality of life, was not assessed in the included study. There were data for two of our secondary outcomes, social and occupational functioning and dropouts (which we used as a proxy for acceptability), but in both cases the evidence was of very low certainty and hence our confidence in the results was very low. For all outcomes, we considered the certainty of the evidence in relation to our review objectives to be low or very low in GRADE terms due to indirectness (because not all participants in the included study had a diagnosis of dementia) and imprecision.

AUTHORS' CONCLUSIONS

This review included one RCT with a low risk of bias. Due to the low certainty of the evidence, the true effects of DMT as an intervention for dementia may be substantially different from those found. More RCTs are needed to determine with any confidence whether DMT has beneficial effects on dementia.

Music-based interventions in rehabilitation of children and adolescents with chronic diseases: Sharing an experience from a Brazilian public hospital

Music-based interventions (MBI) in therapeutic routine have been observed as an effective tool for adjuvant therapy for patients with chronic diseases and for those with various types of disabilities. Music can serve as a pedagogical and therapeutic strategy for development of psychomotor skills in children and adolescents with long-lasting illnesses, and also as a secular way of promoting comfort and spiritual health for patients and families during difficult times; it can also be used to alleviate suffering during diagnostic and therapeutic procedures throughout the long recovery and/or rehabilitation processes. In this article, a musician and art therapist describes some simple MBI used daily in a tertiary children's hospital in Sao Paulo, where patients with chronic diseases and from lower socioeconomic background represent most of outpatients and inpatients. Some MBI developed or adapted by the author are described in detail, some of them using only the voice and others utilizing simple musical instruments, usually percussion ones, by the patients themselves. There are also reports describing MBI in special situations, such as long-lasting isolation of immunosuppressed patients (for bone marrow transplantation, for example), regular day-hospital visits for hemodialysis and religious songs for families of end-of-life or critically ill patients. In conclusion, MBI can be beneficial for improving patient experience in hospital settings, particularly for those with long-lasting or repeated stays, and can be performed in a simple and playful way, with contribution of other health professionals with some background in music, since music therapy specialists are still scarce in many countries.

Musical preferences of Indian children with autism spectrum disorder and acceptability of music therapy by their families: An exploratory study

Background

Music therapy has been in use for children with autism spectrum disorder (ASD) since the 1940s. However, there is limited scientific evidence on its use in the Indian context.

Aim

The present study aims to explore musical preferences of children with ASD and their caregivers' acceptability of music as a form of intervention.

Materials and Methods

It is a cross-sectional study of 120 subjects diagnosed with ASD as per the Diagnostic and Statistical Manual of Mental Disorders-5 identified by convenience sampling. A semi-structured interview schedule consisting of 25 objective response questions with multiple choices and 11 open-ended questions (pertaining to music and the use of music) was used to explore caregivers'/parents' thoughts and beliefs. The responses to open-ended questions were collected in narrative mode. A descriptive approach of content analysis was adopted to analyse the data. The data are presented using descriptive statistics. Institutional Ethics Committee's approval was obtained for conducting the study.

Results

Most of the children liked (89.2%, n = 107) music and responded (88.3%, n = 106) actively (listen intently/hum or sing or dance along) to music. Most subjects preferred rhythm (65%, n = 78) over melody (15%, n = 18). While 98.3% (n = 118) of the parents were willing to try music therapy for their child, 61% of them (n = 72) asked follow-up questions like - "Is there available data on it?" (n = 12; 10.2%) and "Will it be worth investing our time and efforts on it?" (n = 60; 50.8%).

Conclusion

Most of the children including those with auditory sensitivity like music and prefer rhythm over melody. Caregivers possess a positive attitude toward the use of music therapy. However, most of them wish to clarify the scientific basis of the same.

Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new?

Autistic subjects represent a severe concern to dentistry due to the considerable difficulty in managing their oral health, maintaining routine toothbrushing, and preventing dental and periodontal problems. The social and economic burden of managing dental care in autism spectrum disorder (ASD) children is particularly cumbersome for families and public and private health expenditure, especially when children reach the dentist following a late diagnosis with evident oral health problems. An early diagnosis of ASD helps dentists better address these children's oral health. Unfortunately, insufficient attention is paid to the training and education of general pediatricians, dentists, and dental hygienists, allowing them to get to approach the different clinical aspects of ASD. Usually, children diagnosed with ASD are scheduled for dental appointments like their neurotypical peers, whereas their needs are typically complex and personalized. Scant attention is also devoted to these patients by commercial manufacturers of dental products and devices for oral hygiene and prevention of caries and periodontal diseases, leaving parents without the support and often failing when they address the oral health of autistic children. The difficulties of oral care do not derive simply from the behavior of ASD patients, as is commonly assumed, and therefore cannot be overcome solely by the patience and attention of parents and dentists. Genetics, dietary habits, sensory impairments, and cognition disorders are other causes contributing in various degrees to the impact on the mood and psychological reactions of autistic children towards dentists. How can we prevent teeth caries, periodontal disorders, and other oral health impairments by properly managing ASD children? This manuscript gives an up-to-date overview of these problems and helps to provide good remarks.