Music therapy for children with autism: investigating social behaviour through music

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/.

Response to Music-Mediated Intervention in Autistic Children with Limited Spoken Language Ability

PURPOSE

Autistic children with limited spoken language ability (LSLA) often do not respond to traditional interventions, reducing their social inclusion. It is essential to identify effective interventions, and sensitive measures to track their intervention response.

METHODS

Using data from an RCT comparing music-mediated and play-based interventions, we investigated the impact of spoken language ability on outcomes, and measured response to intervention through natural language sample measures.

RESULTS

Children with lower verbal IQ, relative to higher verbal IQ, made some greater gains over the course of music-mediated intervention. Natural language samples were helpful in characterizing communication and tracking change.

CONCLUSION

Music-mediated interventions hold promise as effective interventions for autistic children with LSLA. Natural language samples are robust in characterizing this subgroup.

Nurse-Implemented Music Therapy to Reduce Anxiety in Community-Dwelling Individuals with Severe Mental Illness: A Pilot Study

Anxiety is an important and recurrent problem in people with severe mental illness (SMI). The aim of this work is to measure the effectiveness of the Music Therapy nursing intervention in reducing anxiety in outpatients diagnosed with SMI (bipolar disorder and schizophrenia). The intervention was structured over five weeks (ten 1-h sessions, twice weekly). Objective measures (blood pressure, heart rate, and respiratory rate) and subjective measures (anxiety response and the subjective perception of relaxation) were taken before and after every session. Our results show that this nursing intervention entails an objective reduction of the respiratory rate ((-4.5, -0.5) breaths per minute), the heart rate ((-5.80, -2.13) bpm), and it evidences a reduction in the subjective perception of anxiety (16.08% mean reduction in state anxiety). Considering all the sessions, the subjective perception of relaxation increased 97.33% of the time. This study provides evidence that the Music Therapy intervention can effectively promote relaxation and reduce anxiety symptoms in people with SMI. This study was retrospectively registered at Clinical Trials with Protocol Identifier NCT06315049.

Music Therapy in Pediatric Asthma: A Short Review

Music therapy (MT) is a common modality that performs a complementary and integrative role along with standard treatments for many pediatric diseases. This article briefly reviewed the effects of MT on children aged 5-11 years old and adolescents with asthma from previous studies, specified its functional target towards asthma symptoms, and sorted out the design and investigation of selected research. Medline/PubMed, Embase, SportDis-cus, Cochrane Library, Teacher Reference Centre, Web of Science, Academic Search Complete, PsycARTICLES, and Scopus were queried for experimental and observational studies published between 1990 and 2021. Then, researchers showed that MT lessened patients' asthma symptoms, improved medication compliance, pulmonary function, and quality of life, and helped children and their parents manage anxiety and depression. This article may serve as a reference for clinical research for pediatric asthma therapies and lay the foundation for future research on MT and its clinical practice.

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.

Discourse-based psychological intervention alleviates perioperative anxiety in patients with adolescent idiopathic scoliosis in China: a retrospective propensity score matching analysis

PURPOSE

To evaluate the effectiveness of a discourse-based psychological intervention on perioperative anxiety, pain and life satisfaction of patients with AIS.

METHODS

Between April 2018 and February 2021, 116 consecutive patients with AIS undergoing corrective surgery were enrolled in this study, including 51 with personalized psychological intervention (intervention group, IG) and 65 without (control group, CG). After propensity score matching (PSM), patient characteristics, perioperative scores of anxiety and life satisfaction, measured by values of Generalized Anxiety Disorder 7-item Scale (GAD-7) and Life Satisfaction Index Z scale (LSIZ), were recorded. Mixed linear models were used to estimate the influence of intervention group and time of measurement, as well as their interactions, in anxiety and life satisfaction. Data on post-surgical pain in both groups was also collected and analyzed.

RESULTS

After PSM, a total of 90 patients (IG, n = 45; CG, n = 45) were enrolled in this study, and the 2 groups were comparable in patients' demographic and baseline characteristics. There were no pre-intervention between-group differences in the degree of anxiety (IG: 3.98 ± 3.27 vs. CG: 3.93 ± 3.20, p = .948, Cohen's d = 0.015), and life satisfaction (IG: 6.56 ± 1.70 vs. CG: 6.67 ± 2.09, p = .783, Cohen's d = -0.058). After surgery, participants in both IG and CG showed improved the levels of anxiety (GAD-7: IG 2.18 ± 1.21; CG 2.87 ± 2.00) and life satisfaction (LSIZ: IG 9.84 ± 2.09; CG 9.02 ± 2.15). A stratified analysis of patients with generalized anxiety disorder showed improved anxiety (GAD-7: IG 3.50 ± 1.22 vs. CG 6.80 ± 2.05, p = .017, Cohen's d = -1.956) and lower pain level (VAS: IG 4.50 ± 1.76 vs. CG 7.00 ± 1.00, p = .017, Cohen's d = -1.747) in the IG than the CG after surgery.

CONCLUSIONS

Discourse-based psychological intervention before surgery can improve perioperative anxiety and life satisfaction, and postoperative painful condition, especially for patients with high-leveled pre-surgical anxiety.

Autism Spectrum Disorder and Complementary-Integrative Medicine

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects 0.6%-1.7% of children. The etiology of autism is hypothesized to include both biological and environmental factors (Watts, 2008). In addition to the core symptoms of social-communication delay and restricted, repetitive interests, co-occurring irritability/aggression, hyperactivity, and insomnia negatively impact adaptive functioning and quality of life of patients and families. Despite years of effort, no pharmacologic agent has been found that targets the core symptoms of ASD. The only FDA-approved agents are risperidone and aripiprazole for agitation and irritability in ASD, not for core symptoms. Though they effectively reduce irritability/violence, they do so at the expense of problematic side effects: metabolic syndrome, elevated liver enzymes, and extrapyramidal side effects. Thus, it is not surprising that many families of children with ASD turn to nonallopathic treatment, including dietary interventions, vitamins, and immunomodulatory agents subsumed under complementary-integrative medicine (CIM). Per recent studies, 27% to 88% of families report using a CIM treatment. In an extensive population-based survey of CIM, families of children with more severe ASD, comorbid irritability, GI symptoms, food allergies, seizures, and higher parental education tend to use CIM at higher rates. The perceived safety of CIM treatments as "natural treatment" over allopathic medication increases parental comfort in using these agents. The most frequently used CIM treatments include multivitamins, an elimination diet, and Methyl B12 injections. Those perceived most effective are sensory integration, melatonin, and antifungals. Practitioners working with these families should improve their knowledge about CIM as parents currently perceive little interest in and poor knowledge of CIM by physicians. This article reviews the most popular complementary treatments preferred by families with children with autism. With many of them having limited or poor quality data, clinical recommendations about the efficacy and safety of each treatment are discussed using the SECS versus RUDE criteria.

A bibliometric analysis of global research status and trends in neuromodulation techniques in the treatment of autism spectrum disorder

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disease which has risen to become the main cause of childhood disability, placing a heavy burden on families and society. To date, the treatment of patients with ASD remains a complicated problem, for which neuromodulation techniques are a promising solution. This study analyzed the global research situation of neuromodulation techniques in the treatment of ASD from 1992 to 2022, aiming to explore the global research status and frontier trends in this field.

METHODS

The Web of Science (WoS) was searched for literature related to neuromodulation techniques for ASD from 1992 to October 2022. A knowledge atlas to analyze collaboration among countries, institutions, authors, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, and burst keywords was constructed using Rstudio software, CiteSpace, and VOSviewer.

RESULTS

In total, 392 publications related to the treatment of ASD using neuromodulation techniques were included. Despite some fluctuations, the number of publications in this field has shown a growing trend in recent years. The United States and Deakin University are the leading country and institution in this field, respectively. The greatest contributing authors are Peter G Enticott, Manuel F Casanova, and Paul B Fitzgerald et al. The most prolific and cited journal is Brain Stimulation and the most commonly co-cited journal is The Journal of Autism and Developmental Disorders. The most frequently cited article was that of Simone Rossi (Safety, ethical considerations, and application guidelines for the use of transverse magnetic stimulation in clinical practice and research, 2009). "Obsessive-compulsive disorder," "transcranial direct current stimulation," "working memory," "double blind" and "adolescent" were identified as hotspots and frontier trends of neuromodulation techniques in the treatment of ASD.

CONCLUSION

The application of neuromodulation techniques for ASD has attracted the attention of researchers worldwide. Restoring the social ability and improving the comorbid symptoms in autistic children and adults have always been the focus of research. Neuromodulation techniques have demonstrated significant advantages and effects on these issues. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are new therapeutic methods introduced in recent years, and are also directions for further exploration.

Analysis of the value of folk music intangible cultural heritage on the regulation of mental health

This paper proposes an approach based on the safeguarding of intangible cultural heritage (ICH) by studying the value of ICH to explore the value of the ICH of folk music on mental health and its safeguarding measures. Additionally, a questionnaire survey is conducted on the value of the ICH of folk music among college students. The Tibetan Guozhuang dance and music in the ICH are taken as the object. The students' awareness, participation, and effects on physical and mental health, emotional regulation, and stress regulation are investigated, to study the safeguarding value of folk music. The survey results reveal that in the process of participating in the folk art of Tibetan Guozhuang dance, 41.8% of the students consider it very useful for emotional regulation and stress relief, and 46.31% believe it is useful. 36.95% of the students feel that it is very useful for the development of mental health, and 49.75% think it is useful. This indicates that a total of 86.7% of the students believe that the dance is helpful to the development of students' mental health. And most of the students are in a happy mood when participating in the dance. Among them, 71.7% of the students say that they are elated, and 66.98% feel that they are excited. It illustrates that as a young group, the students are fond of folk art, but they lack the cognitive approach. Finally, the safeguarding suggestions and implementation paths are put forward in view of the existing problems of the ICH of folk music. The research can provide a research reference for the safeguarding of the ICH of folk music.

Putting music to trial: Consensus on key methodological challenges investigating music-based rehabilitation

Major advances in music neuroscience have fueled a growing interest in music-based neurological rehabilitation among researchers and clinicians. Musical activities are excellently suited to be adapted for clinical practice because of their multisensory nature, their demands on cognitive, language, and motor functions, and music's ability to induce emotions and regulate mood. However, the overall quality of music-based rehabilitation research remains low to moderate for most populations and outcomes. In this consensus article, expert panelists who participated in the Neuroscience and Music VII conference in June 2021 address methodological challenges relevant to music-based rehabilitation research. The article aims to provide guidance on challenges related to treatment, outcomes, research designs, and implementation in music-based rehabilitation research. The article addresses how to define music-based rehabilitation, select appropriate control interventions and outcomes, incorporate technology, and consider individual differences, among other challenges. The article highlights the value of the framework for the development and evaluation of complex interventions for music-based rehabilitation research and the need for stronger methodological rigor to allow the widespread implementation of music-based rehabilitation into regular clinical practice.

Isn't There Room for Music in Chronic Pain Management?

Chronic pain with its comorbidities, such as depression, insomnia, and social deprivation, is a major cause of disability and health-economic burden. Insufficient response to pain medication and potentially serious adverse effects have led the majority of chronic pain patients to seek relief from non-pharmacological remedies. Along with this trend, pain research has paid increasing interest in critical evaluation of various complementary treatments. Music-based treatments have emerged as an efficacious and safe means to enhance the management of acute and chronic pain. We review the current position of music-based interventions in the treatment of chronic pain and present explanations for the analgesic effects of music through modulation of the primary nociception and discuss the contribution of the mesolimbic dopaminergic system to the affective component of pain perception. We propose ways to translate the novel theoretical understanding into clinical practice in different health care settings, primary health care in particular, and discuss the preconditions of successful implementation. We argue that music interventions provide low-cost, easily applicable complementary pain treatments not requiring heavy utilization of health care resources. Finally, we provide research and quality improvement frameworks and make suggestions to cover the gaps of existing evidence. PERSPECTIVE: This article addresses the current evidence for analgesic effects of music interventions, discusses its neurobiological basis and evaluates potential use of music in treating chronic pain patients in different health care settings. We also propose directions for future research to cover shortages in the currently published data.

Music therapy for autistic people

BACKGROUND

Social interaction and social communication are among the central areas of difficulty for autistic people. Music therapy uses music experiences and the relationships that develop through them to enable communication and expression, thus attempting to address some of the core problems of autistic people. Music therapy has been applied in autism since the early 1950s, but its availability to autistic individuals varies across countries and settings. The application of music therapy requires specialised academic and clinical training which enables therapists to tailor the intervention to the specific needs of the individual. The present version of this review on music therapy for autistic people is an update of the previous Cochrane review update published in 2014 (following the original Cochrane review published in 2006).

OBJECTIVES

To review the effects of music therapy, or music therapy added to standard care, for autistic people.

SEARCH METHODS

In  August 2021, we searched  CENTRAL, MEDLINE, Embase, eleven other databases and two trials registers. We also ran citation searches, checked reference lists, and contacted study authors to identify additional studies.

SELECTION CRITERIA

All randomised controlled trials (RCTs), quasi-randomised trials and controlled clinical trials comparing music therapy (or music therapy alongside standard care) to 'placebo' therapy, no treatment, or standard care for people with a diagnosis of autism spectrum disorder were considered for inclusion.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures. Four authors independently selected studies and extracted data from all included studies. We synthesised the results of included studies in meta-analyses. Four authors independently assessed risk of bias (RoB) of each included study using the original RoB tool as well as the certainty of evidence using GRADE.   MAIN RESULTS: We included 16 new studies in this update which brought the total number of included studies to 26 (1165 participants). These studies examined the short- and medium-term effect of music therapy (intervention duration: three days to eight months) for autistic people in individual or group settings. More than half of the studies were conducted in North America or Asia. Twenty-one studies included children aged from two to 12 years. Five studies included children and adolescents, and/or young adults. Severity levels, language skills, and cognition were widely variable across studies. Measured immediately post-intervention, music therapy compared with 'placebo' therapy or standard care was more likely to positively effect global improvement (risk ratio (RR) 1.22, 95% confidence interval (CI) 1.06 to 1.40; 8 studies, 583 participants; moderate-certainty evidence; number needed to treat for an additional beneficial outcome (NNTB) = 11 for low-risk population, 95% CI 6 to 39; NNTB = 6 for high-risk population, 95% CI 3 to 21) and to slightly increase quality of life (SMD 0.28, 95% CI 0.06 to 0.49; 3 RCTs, 340 participants; moderate-certainty evidence, small to medium effect size). In addition, music therapy probably results in a large reduction in total autism symptom severity (SMD -0.83, 95% CI -1.41 to -0.24; 9 studies, 575 participants; moderate-certainty evidence). No clear evidence of a difference between music therapy and comparison groups at immediately post-intervention was found for social interaction (SMD 0.26, 95% CI -0.05 to 0.57, 12 studies, 603 participants; low-certainty evidence); non-verbal communication (SMD 0.26, 95% CI -0.03 to 0.55; 7 RCTs, 192 participants; low-certainty evidence); and verbal communication (SMD 0.30, 95% CI -0.18 to 0.78; 8 studies, 276 participants; very low-certainty evidence). Two studies investigated adverse events with one (36 participants) reporting no adverse events; the other study found no differences between music therapy and standard care immediately post-intervention (RR 1.52, 95% CI 0.39 to 5.94; 1 study, 290 participants; moderate-certainty evidence).  AUTHORS' CONCLUSIONS: The findings of this updated review provide evidence that music therapy is probably associated with an increased chance of global improvement for autistic people, likely helps them to improve total autism severity and quality of life, and probably does not increase adverse events immediately after the intervention. The certainty of the evidence was rated as 'moderate' for these four outcomes, meaning that we are moderately confident in the effect estimate. No clear evidence of a difference was found for social interaction, non-verbal communication, and verbal communication measured immediately post-intervention. For these outcomes, the certainty of the evidence was rated as 'low' or 'very low', meaning that the true effect may be substantially different from these results. Compared with earlier versions of this review, the new studies included in this update helped to increase the certainty and applicability of this review's findings through larger sample sizes, extended age groups, longer periods of intervention and inclusion of follow-up assessments, and by predominantly using validated scales measuring generalised behaviour (i.e. behaviour outside of the therapy context). This new evidence is important for autistic individuals and their families as well as for policymakers, service providers and clinicians, to help in decisions around the types and amount of intervention that should be provided and in the planning of resources. The applicability of the findings is still limited to the age groups included in the studies, and no direct conclusions can be drawn about music therapy in autistic individuals above the young adult age. More research using rigorous designs, relevant outcome measures, and longer-term follow-up periods is needed to corroborate these findings and to examine whether the effects of music therapy are enduring.

The Use of Deep Learning-Based Gesture Interactive Robot in the Treatment of Autistic Children Under Music Perception Education

The purpose of this study was to apply deep learning to music perception education. Music perception therapy for autistic children using gesture interactive robots based on the concept of educational psychology and deep learning technology is proposed. First, the experimental problems are defined and explained based on the relevant theories of pedagogy. Next, gesture interactive robots and music perception education classrooms are studied based on recurrent neural networks (RNNs). Then, autistic children are treated by music perception, and an electroencephalogram (EEG) is used to collect the music perception effect and disease diagnosis results of children. Due to significant advantages of signal feature extraction and classification, RNN is used to analyze the EEG of autistic children receiving different music perception treatments to improve classification accuracy. The experimental results are as follows. The analysis of EEG signals proves that different people have different perceptions of music, but this difference fluctuates in a certain range. The classification accuracy of the designed model is about 72–94%, and the average classification accuracy is about 85%. The average accuracy of the model for EEG classification of autistic children is 85%, and that of healthy children is 84%. The test results with similar models also prove the excellent performance of the design model. This exploration provides a reference for applying the artificial intelligence (AI) technology in music perception education to diagnose and treat autistic children.

Atypical ERP responses to audiovisual speech integration and sensory responsiveness in infants at risk for autism spectrum disorder

Atypical sensory responses are included in the diagnostic criteria of autism spectrum disorder (ASD). Autistic individuals perform poorly during conditions that require integration across multiple sensory modalities such as audiovisual (AV) integration. Previous research investigated neural processing of AV integration in infancy. Yet, this has never been studied in infants at higher likelihood of later ASD (HR) using neurophysiological (EEG/ERP) techniques. In this study, we investigated whether ERP measures of AV integration differentiate HR infants from low-risk (LR) infants and whether early AV integration abilities are associated with clinical measures of sensory responsiveness. At age 12 months, AV integration in HR (n = 21) and LR infants (n = 19) was characterized in a novel ERP paradigm measuring the McGurk effect, and clinical measures of sensory responsiveness were evaluated. Different brain responses over the left temporal area emerge between HR and LR infants, specifically when AV stimuli cannot be integrated into a fusible percept. Furthermore, ERP responses related to integration of AV incongruent stimuli were found to be associated with sensory responsiveness, with reduced effects of AV incongruency being associated with reduced sensory reactivity. These data suggest that early identification of AV deficits may pave the way to innovative therapeutic strategies for the autistic symptomatology. Further replications in independent cohorts are needed for generalizability of findings.

Effectiveness of music therapy in children with autism spectrum disorder: A systematic review and meta-analysis

OBJECTIVES

This study was to investigated the efficacy of music therapy (MT) in children with autism spectrum disorder (ASD) via a meta-analysis that comprehensively evaluated data from all eligible research in this field.

DESIGN

Systematic review and meta-analysis.

SETTING

A systematic search of the PubMed, Embase, and Cochrane Library databases from inception to October 2021 to identify studies that administered MT to children with ASD.

RESULTS

Eight randomized controlled trials (RCTs) including 608 participants met the inclusion criteria. The meta-analysis showed that MT was associated with a significant increase in social reactions among children with ASD (standardized mean difference (SMD) = 0.24, 95% confidence interval (CI) [0.03, 0.46], I ² = 0%, P = 0.03). However, MT did not elicit a significant increase in symptom severity (SMD = 0.17, 95% CI [-0.04,0.38], I ² = 0%,P = 0.12), social adaptive behavior (SMD = 0.02, 95% CI [-0.44,0.48], I ² = 0%,P = 0.93) or speech (SMD = 0.04, 95% CI [-0.39, 0.47], I ² = 0%, P = 0.86) in children with ASD.

CONCLUSION

MT can improve social skills in children with ASD; however, there does not seem to be a consensus on the persistence of its effects. These findings can inform clinical practice. Promoting the use of MT in children with ASD and improving its symptoms are the ultimate goals.

Evaluating the benefits of inclusive community singing towards well-being: narratives of diverse community members attending an inclusive singing group

Purpose

The purpose of this paper is to evaluate the benefits of an inclusive community singing group towards well-being.

Design/methodology/approach

This study used an exploratory qualitative study (EQS) approach. Semi-structured questions were devised and used to elicit participants’ experiences on the impact of an inclusive community singing group towards well-being. A thematic approach underpinned by the four phases of The Silences Framework was used to analyse the data.

Findings

This study found the following benefits of an inclusive community singing group towards well-being Connecting with others, Physical improvement, Learning new skills, Giving to others and Mindfulness.

Originality/value

This study concluded that inclusive community singing plays a pivotal role in enhancing the health and well-being of communities.

Joint engagement and movement: Active ingredients of a music-based intervention with school-age children with autism

BACKGROUND

The effectiveness of music-based interventions (MI) in autism has been attested for decades. Yet, there has been little empirical investigation of the active ingredients, or processes involved in music-based interventions that differentiate them from other approaches.

OBJECTIVES

Here, we examined whether two processes, joint engagement and movement, which have previously been studied in isolation, contribute as important active ingredients for the efficacy of music-based interventions.

METHODS

In two separate analyses, we investigated whether (1) joint engagement with the therapist, measured using a coding scheme verified for reliability, and (2) movement elicited by music-making, measured using a computer-vision technique for quantifying motion, may drive the benefits previously observed in response to MI (but not a controlled non-MI) in children with autism.

RESULTS

Compared to a non-music control intervention, children and the therapist in MI spent more time in triadic engagement (between child, therapist, and activity) and produced greater movement, with amplitude of motion closely linked to the type of musical instrument.

CONCLUSIONS

Taken together, these findings provide initial evidence of the active ingredients of music-based interventions in autism.

Evaluation of the Use of Real-time 3D Graphics to Augment Therapeutic Music Sessions for Young People on the Autism Spectrum

The present research evaluates the effectiveness of CymaSense, a real-time 3D visualisation application developed by the authors, as a means of improving the communicative behaviours of autistic participants through the addition of a visual modality within therapeutic music sessions. Autism spectrum condition (ASC) is a lifelong neurodevelopmental disorder that can affect people in a number of ways, commonly through difficulties in communication. A multi-sensory approach within music sessions encourages people with ASC to engage more with the act of creating music, and with the therapists, increasing their level of communication and social interaction beyond the sessions.

This article presents a study evaluating the use of CymaSense within a series of therapeutic music sessions, and a follow-up series of semi-structured interviews. Eight adults with ASC participated in 12 sessions using a single case experimental design approach over a total period of 19 weeks. Using qualitative and quantitative data, the results show an increase in communicative behaviour, for both verbal and non-verbal participants, resulting from the use of CymaSense. Qualitative feedback from interviews provided insight into the factors that contribute to the successful use of the application, as well as aspects that could be improved.

Attunement in Music Therapy for Young Children with Autism: Revisiting Qualities of Relationship as Mechanisms of Change

This study examined whether musical and emotional attunement predicts changes in improvisational music therapy with children with autism (4–7 years, N = 101, majority: no/limited speech, low IQ), assessed over 12 months. Attunement, as observed from session videos, and changes in generalized social skills, judged by blinded assessors and parents, were evaluated using standardized tools (Assessment of the Quality of Relationship, Improvisational Music Therapy Principles, ADOS, SRS). In contrast to the smaller pilot, we did not find significant effects between attunement and changes in outcomes, only tendencies in the same direction are observed. Findings suggest that symptom severity is associated with the therapist’s ability to attune to the child. They further raise questions concerning outcome selection and user involvement.

Parents, Peers, and Musical Play: Integrated Parent-Child Music Class Program Supports Community Participation and Well-Being for Families of Children With and Without Autism Spectrum Disorder

Opportunities for meaningful community participation may influence the development and well-being of individuals with autism spectrum disorder (ASD) and their families as well as impact how community members perceive and understand ASD. In the current study, we aimed to understand how a parent-child integrated music class program could be used to promote community participation and family well-being. Caregivers of preschoolers (2-5 years of age) with ASD and those of peer children with typical development (TD) were interviewed about their participation in a parent-child integrated music class program. Thematic analysis of interviews revealed that all caregivers viewed program participation as positive. Caregivers emphasized increasing connections within families, such as through strengthening parent-child bonds, as well as connections across families, including increased understanding of ASD and sensitivity to the experience of parenting. Many caregivers perceived the class as supporting their parenting and impacting their children's behavior in meaningful ways. Interview themes were supported by measures of caregiver and child program receipt, including questionnaires about family music engagement throughout their time in the class program and behavioral coding of children's engagement during music classes. Findings suggest that integrated community experiences such as parent-child music classes may impact whole family well-being, highlighting the value of integrated community participation experiences at the level of the family system. Parent-child music classes may provide a productive and accessible context for supporting integrated community experiences.

PRESS-Play: Musical Engagement as a Motivating Platform for Social Interaction and Social Play in Young Children with ASD

Musical experiences are ubiquitous in early childhood. Beyond potential benefits of musical activities for young children with typical development, there has long been interest in harnessing music for therapeutic purposes for individuals with autism spectrum disorder (ASD). However, there is debate as to the effectiveness of these approaches and thus a need to identify mechanisms of change (or active ingredients) by which musical experiences may impact social development in young children with ASD. In this review, we introduce the PRESS-Play framework, which conceptualizes musical activities for young children with ASD within an applied behavior analysis framework consistent with the principles of naturalistic developmental behavioral interventions. Specifically, the PRESS-Play framework proposes that musical activities support key elements of evidence-based approaches for social engagement including predictability, reinforcement, emotion regulation, shared attention, and social play context, providing a platform for delivery and receipt of social and behavioral instruction via a transactional, developmental approach. PRESS-Play considers that these factors may impact not only the child with ASD but also their interaction partner, such as a parent or peer, creating contexts conducive for validated social engagement and interaction. These principles point to focused theories of change within a clinical-translational framework in order to experimentally test components of social-musical engagement and conduct rigorous, evidence-based intervention studies.