Musical Attention Control Training (MACT) in secure residential youth care: A randomised controlled pilot study

Allied health professional support for children and young adults living in and leaving care: A systematic scoping review

BACKGROUND

Children and young people living in and leaving care are known to have experienced significant childhood adversity and trauma resulting in potentially deleterious impact on their health and well-being across the life course. Studies point to the complex needs of this population who may benefit from allied health professional (AHP)-related support with limited studies located. This review sought to address this gap by systematically scoping empirical literature focused on the provision of AHP support to this cohort of children and young adults to assist an understanding of the service needs for this vulnerable population.

METHODS

This scoping review followed Arskey and O'Malley's five steps framework (2005) to identify and review relevant literature. A focus on identifying the evidence, challenges and gaps in research relating to AHP support for children and young people living in and leaving care was initially agreed, followed by a systematic search using a combination of three key concepts to identify relevant studies in five AHP disciplinary areas to identify best evidence in the past decade (2011-2021). Study inclusion criteria were based on empirical studies of children and young people living in care (0-17 years) and leaving care (18-25 years). A data extraction table was formulated as a means of charting the data, aligned with the scope and objectives of this review. Finally, data were subsequently collated, synthesised and reported based on key thematic areas emerging from included studies regarding AHP support to children and young people living in and leaving care.

RESULTS

A total of 13 studies met the review inclusion criteria. Included studies reported specifically on speech and language therapist (SLT; n = 5), occupational therapist (OT; n = 3) and arts-based therapies (n = 5). No studies were identified with regard to the use of physiotherapy and dietetics with this population. Results indicated that children and young people living in and leaving care have high rates of speech, language, communication and sensory needs. More rigorous screening, assessment and early intervention were identified as essential for this vulnerable group. Increased multidisciplinary collaboration and OT support for young adults in preparation for transition to independent living was identified as an urgent requirement. Included studies indicate promising results in relation to access to arts-based therapies with particular reference to identity formation for children and young people living in and leaving care.

CONCLUSIONS

Although evidence of effectiveness remains limited, AHP service provision (specifically speech and language therapy, occupational therapy and arts-based therapies) has the potential to contribute positively to addressing the complex and interacting needs of this vulnerable population. As a result, it is recommended that AHP service provision is integrated into the collaborative, multidisciplinary care available to children living in and leaving care. More extensive, higher quality research related to the benefits of AHP provision for this population of children and young people is essential to provide a more robust evidence base across the various professional disciplines that constitute allied health provision.

The adolescent HIV executive function and drumming (AHEAD) study, a feasibility trial of a group drumming intervention amongst adolescents with HIV

AHEAD feasibility trial assessed the feasibility and acceptability of an 8-session group drumming programme aiming to improve executive function, depression and anxiety symptoms, and perceived social support in adolescents living with HIV in a rural low-income South African setting. Sixty-eight 12- to 19-year-old adolescents participated. They were individually randomised. The intervention arm (n = 34) received weekly hour-long group drumming sessions. Controls (n = 34) received no intervention. Feasibility and acceptability were assessed using rates of: enrolment; retention; attendance; logistical problems; adolescent-reported acceptability. Secondary measures included: five Oxford Cognitive Screen-Executive Function (OCS-EF) tasks; two Rapid Assessment of Cognitive and Emotional Regulation (RACER) tasks; the Self-Reporting Questionnaire-20 (SRQ-20) measuring depression and anxiety symptoms; the Multidimensional Scale of Perceived Social Support (MSPSS). All feasibility criteria were within green progression limits. Enrolment, retention, and acceptability were high. There was a positive effect on adolescent depressed mood with signal for a working memory effect. There were no significant effects on executive function or socio-emotional scales. Qualitative findings suggested socio-emotional benefits including: group belonging; decreased internalised stigma; improved mood; decreased anxiety. Group drumming is a feasible and acceptable intervention amongst adolescents living with HIV in rural South Africa. A full-scale trial is recommended.

Virtual reality-based music attention training for acquired brain injury: A protocol for randomized cross-over trial

Attention training is the primary step in the rehabilitation for patients with acquired brain injury (ABI). While active music performance has been reported to aid neural and functional recovery, its efficacy for patients with ABI remains uncertain due to methodological concerns. The purpose of the study is to develop a virtual reality-based music attention training (VR-MAT), which utilizes a visually guided, bilateral drumming in an immersive environment to train attention and executive functions. We also aims to examine the feasibility and effectiveness of the VR-MAT with a small sample size of participants (3-60 months after ABI, N = 20 approximately). Participants will be randomly assigned to either a waitlist control or music group, in which VR-MAT will take place five times weekly over 4 weeks (randomized crossover design). The evaluation of VR-MAT performance will include accuracy and response time in music responses. Neurocognitive outcome measures will be administered to quantify pre-post changes in attention, working memory, and executive functions. Additionally, functional near-infrared spectroscopy will be employed to explore the relationships between musical behavior, neurocognitive function, and neurophysiological responses.

The Effect of Music Intervention on Attention in Children: Experimental Evidence

Although music has been utilized as a therapeutic tool for children with cognitive impairments, how it improves children’s cognitive function remains poorly understood. As a first step toward understanding music’s effectiveness and as a means of assessing cognitive function improvement, we focused on attention, which plays an important role in cognitive development, and examined the effect of a music intervention on children’s attention. Thirty-five children, aged 6 to 9 years, participated in this study, with data from 29 of the children being included in the analysis. A single 30-minute interactive music intervention was compared with a single 30-minute interactive video game intervention accompanied by computer-generated background music using a within-subjects repeated-measures design. Each intervention was implemented individually. Participants completed a standardized attention assessment, the Test of Everyday Attention for Children, before and after both interventions to assess changes in their attentional skills. The results indicated significant improvement in attention control/switching following the music intervention after controlling for the children’s intellectual abilities, while no such changes were observed following the video game intervention. This study provides the first evidence that music interventions may be more effective than video game interventions to improve attention control in children, and furthers our understanding of the importance of music interventions for children with attention control problems.

New Perspectives on Music in Rehabilitation of Executive and Attention Functions

Modern music therapy, starting around the middle of the twentieth century was primarily conceived to promote emotional well-being and to facilitate social group association and integration. Therefore, it was rooted mostly in social science concepts. More recently, music as therapy began to move decidedly toward perspectives of neuroscience. This has been facilitated by the advent of neuroimaging techniques that help uncover the therapeutic mechanisms for non-musical goals in the brain processes underlying music perception, cognition, and production. In this paper, we focus on executive function (EF) and attentional processes (AP) that are central for cognitive rehabilitation efforts. To this end, we summarize existing behavioral as well as neuroimaging and neurophysiological studies in musicians, non-musicians, and clinical populations. Musical improvisation and instrumental playing may have some potential for EF/AP stimulation and neurorehabilitation. However, more neuroimaging studies are needed to investigate the neural mechanisms for the active musical performance. Furthermore, more randomized clinical trials combined with neuroimaging techniques are warranted to demonstrate the specific efficacy and neuroplasticity induced by music-based interventions.

Musical Attention Control Training for Psychotic Psychiatric Patients: An Experimental Pilot Study in a Forensic Psychiatric Hospital

Poor attention skills constitute a major problem for psychiatric patients with psychotic symptoms, and increase their chances of treatment drop-out. This study investigated possible benefits of musical attention control training (MACT). To examine the effect of MACT on attention skills of psychiatric patients with psychotic features a randomized controlled trial (RCT) was conducted in a forensic psychiatric clinic. Participants (N = 35, age M = 34.7, 69% male) were pair matched (on age, gender, and educational level), and randomly assigned to an experimental and control group. The experimental group received a 30-min MACT training once a week over 6 weeks' time, whereas the controls received treatment as usual without attention training. Single blind pre- and post-neuropsychological assessments were performed to measure different attention levels. The experimental MACT group outperformed the control group in selective, sustained and alternating attention. In addition, overall attendance of MACT participants was high (87.1%). This result suggests that in this experimental pilot study MACT was effective for attention skills of psychiatric patients with psychotic features. To obtain larger intervention effects additional research is necessary, with a larger sample and a more specific MACT intervention.