Music therapy in the assessment and treatment of autistic spectrum disorder: clinical application and research evidence

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.

Developing an Attention Assessment Tool for Individuals With Autism Spectrum Disorder Using Timbre, Rhythm, and Pitch

BACKGROUND

Music is regarded as a beneficial tool for assessing the clinical symptoms and communication skills in individuals with autism spectrum disorder (ASD) or autism. The present study developed a music-based attention test (MAT) for individuals with autism using music parameters and the algorithm of the comprehensive attention test (CAT).

METHODS

We recruited 51 autistic individuals and 50 neurotypical individuals to participate in the CAT, MAT, and social intelligence tests. The reliability and validity of the MAT were assessed using exploratory factor analysis, concurrent validity, and criterion-related validity.

RESULTS

The MAT had sound internal consistency (high Cronbach's α = 0.948). In addition, the MAT had suitable concurrent validity in the correlation between CAT and MAT, as well as good criterion validity when attention was measured using the MAT and was compared between autistic individuals and neurotypical individuals. Attention evaluated using the MAT was associated with the social quotient in individuals with autism.

CONCLUSIONS

The MAT could be a relevant tool for gauging attention in individuals with ASD. Furthermore, attention determined using the MAT may be correlated with social quotient in autistic individuals. Future studies should consider that using music in the field of attention could improve the social quotient of individuals with autism.

Effects of Music Therapy on Vital Signs in Children with Chronic Disease

Background: Recent research found evidence supporting music therapy for hospitalized children with chronic diseases. The aim of this study was to investigate the effect of music therapy on hospitalized children’s vital signs. Methods: In this prospective study, children with chronic gastroenterological and nephrological diseases received active or receptive music therapy two to four times a week until discharge from hospital at the pediatric special care unit (SCU) and pediatric intensive care unit (ICU). Baseline and post-therapy heart rate, oxygen saturation and blood pressure were recorded and analyzed as control values at three points on the same day when the children were alone in their patient room at rest. Results: A total of 83 children, median 3 age of years (range one month to eighteen years) received music therapy. In total, 377 music therapy sessions were treated: 200 receptive therapy (78 ICU, 122 SCU) and 177 with active therapy (0 ICU, 177 SCU). Music therapy interventions showed changes in vital signs during music therapy sessions. After music therapy, heart rates decreased by 18 beats per minute (95% confidence interval (CI), −19.4 to (−16.8)), oxygen saturation increased by 2.3% (95% CI, 2.2 to 2.5), systolic blood pressure decreased by 9.2 (95% CI, −10.6 to −7.7) and diastolic blood pressure decreased by 7.9 (95% CI, −9.6 to −6.3). When music therapy was applied at the SCU (ICU), heart rates significantly reduced by 17.9 (18.9) beats per min, oxygen saturation increased by 2.4% (2.1%) and blood pressure reduced by 9.2 (2.8) mmHg (systolic) and 7.9 (0.3) mmHg (diastolic). Almost all control values were better than directly before the intervention. However, after music therapy intervention, the children showed better values in vital signs compared to being alone in their patient room. Conclusion: Music therapy is an added value for children with kidney and liver/gastrointestinal diseases during their hospital stay.

Where words are powerless to express: Use of music in paediatric neurology

Music is an art form that strongly affects people and can elicit many different emotions at the same time, including happiness, anxiety, sadness, and even ecstasy. What is it about music that causes such a strong reaction from each of us? Music engages many senses, which in turn can produce a multiplicity of responses and help create more extensive neuronal connections, as well as influence behaviour through structural and functional changes in the brain. Music-based interventions as a therapeutic tool in rehabilitation are becoming more common. It is said that the impact of music on the human body is positive. However, what impact does music have on the young nervous system, especially the affected one? This review presents the advantages and disadvantages of the use of music in paediatric neurology to treat dyslexia, cerebral palsy, and stroke, among others. Potential negative impacts such as musicogenic epilepsy and hallucinations will be discussed.

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.

Music Technology as a Means for Fostering Young Children’s Social Interactions in an Inclusive Class

This research investigated how children aged five to six performed in social interactions and participation by learning American English through music technology activities in an inclusive class. The purposes of this research were to analyze, through music technology activities, the social interactions and participation of children in the inclusive class. Therefore, the research question was as follows: can music technology activities significantly improve children’s social interactions and participation in an inclusive class? There were two themes for the research teaching, each of which included seven weeks of instruction. The teaching content involved three stages, which were pre-test, implementation, and post-test. The research teaching was given 40 min per session twice a week and continued for 14 weeks with 28 teaching times. The methodology primarily consisted of a qualitative assessment of participation, observations, and interviews. In addition to collecting and analyzing qualitative data, quantitative data were also employed in the study. Data sources were semi-structured observation forms, anecdote records, language test scales and interview records, and feedback forms. The results indicated that all children had positive performance in social interactions and participating motivation, as supported by statistical results of social validity. Furthermore, the children’s cooperation and communication effectively improved through music technology activities. Nevertheless, the limitation of the study is the insufficient number of participants involved in the evaluation. For future research, utilizing more than 30 samples would be more appropriate and would supplement the social network analysis to carry out more in-depth investigations and discussions.

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.

How Technology Applied to Music-Therapy and Sound-Based Activities Addresses Motor and Social Skills in Autistic Children

Autism affects how people perceive and make sense of the world around them. Autism is a spectrum condition which impacts people in different ways. Also referred to as Autism Spectrum Disorder (ASD), it is characterized by challenges in the domains of social, cognitive and motor functioning, which differ in severity. Previous research suggests that music can have cognitive, psychosocial, behavioural, and motor benefits in this population. We systematically review the use of technology in Music-therapy and related sound-based activities to improve the motor and social skills of children. In May 2020 we conducted a systematic search on Music-therapy and musical activities for autistic children in research databases including Science Direct, APA PsycNet, Cochrane, IEE and Web of Science, to collect relevant studies. We initially collected 5179 papers of which only 27 studies were identified as suitable for the scope of this review. In the paper, we analyse and describe key characteristics of each project. We then highlight the commonalities, strengths and limitations of existing work, and identify implications for future interaction design.

Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model

Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

A preliminary investigation of a school-based musical theater intervention program for children with intellectual disabilities

The presence of an intellectual disability may cause a child to have significant deficits in social skills and emotion regulation abilities across development. A vital next step is to find interventions that can be delivered in the school environment and across disability categories that target socioemotional factors. The current study investigated the feasibility of delivering a school-based musical theater program to students with intellectual disability across a range of school settings. A within-group repeated-measures design was used to analyze pre- and post-video recordings of the intervention program, which were coded for six domains of socioemotional ability across all participants ( n = 47). Results showed that significant gains across all domains were observed. However, these gains related to school- and individual-level student factors, such as grade level, severity of disability, and baseline social skill ability.

International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study

BACKGROUND

Preliminary studies have indicated that music therapy may benefit children with autism spectrum disorders (ASD).

OBJECTIVES

To examine the effects of improvisational music therapy (IMT) on social affect and responsiveness of children with ASD.

DESIGN

International, multicentre, three-arm, single-masked randomised controlled trial, including a National Institute for Health Research (NIHR)-funded centre that recruited in London and the east of England. Randomisation was via a remote service using permuted blocks, stratified by study site.

SETTING

Schools and private, voluntary and state-funded health-care services.

PARTICIPANTS

Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent or guardian who provided written informed consent. We excluded children with serious sensory disorder and those who had received music therapy within the past 12 months.

INTERVENTIONS

All parents and children received enhanced standard care (ESC), which involved three 60-minute sessions of advice and support in addition to treatment as usual. In addition, they were randomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESC alone, over 5 months in a ratio of 1 : 1 : 2.

MAIN OUTCOME MEASURES

The primary outcome was measured using the social affect score derived from the Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment. Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and 12 months (higher scores indicated greater impairment).

RESULTS

A total of 364 participants were randomised between 2011 and 2015. A total of 182 children were allocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocated to ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) in the intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171 (94.0%) received it. From baseline to 5 months, mean scores of ADOS social affect decreased from 14.1 to 13.3 in music therapy and from 13.5 to 12.4 in standard care [mean difference: music therapy vs. standard care = 0.06, 95% confidence interval (CI) -0.70 to 0.81], with no significant difference in improvement. There were also no differences in the parent-rated social responsiveness score, which decreased from 96.0 to 89.2 in the music therapy group and from 96.1 to 93.3 in the standard care group over this period (mean difference: music therapy vs. standard care = -3.32, 95% CI -7.56 to 0.91). There were seven admissions to hospital that were unrelated to the study interventions in the two IMT arms compared with 10 unrelated admissions in the ESC group.

CONCLUSIONS

Adding IMT to the treatment received by children with ASD did not improve social affect or parent-assessed social responsiveness.

FUTURE WORK

Other methods for delivering music-focused interventions for children with ASD should be explored.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN78923965.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 59. See the NIHR Journals Library website for further project information.

The Effect of Music on Exercise Intensity among Children with Autism Spectrum Disorder: A Pilot Study

Children with autism spectrum disorder (ASD) are at risk for obesity, commonly have sleep disorders, and exhibit stereotypic behaviors that disrupt their learning. Vigorous levels of exercise have been shown to ameliorate these issues in children with ASD, but little research exists to provide techniques for motivating children with ASD to engage in exercise. The present study examined the effect of music on exercise intensity in a group of 13 elementary school students with ASD. Data were collected across six days during structured (e.g., verbal and physical prompts) and unstructured (e.g., minimal prompting) exercise periods. During these exercise periods, three music conditions were randomized: no music, slow-tempo music, and fast-tempo music. Exercise intensity, measured in Metabolic Equivalent of Tasks by triaxial accelerometers, was greatest during the structured exercise periods and during the slow music condition. Student characteristics moderated the impact of music condition on exercise intensity, such that students with high levels of adaptive behavior or lower levels of maladaptive behavior displayed greater exercise intensity during the fast music condition.

Salivary α-amylase as a marker of stress reduction in individuals with intellectual disability and autism in response to occupational and music therapy

BACKGROUND

Although the benefits of a range of disability-centric therapies have been well studied, little remains known about how they work, let alone how to monitor these benefits in a precise and reliable way.

METHODS

Here, in two independent studies, we examine how sessions consisting of occupational or music therapy, both widely recognised for their effectiveness, modulate levels of salivary α-amylase (sAA), a now time- and cost-efficient marker of stress, in individuals with intellectual disability and autism spectrum disorder. Pre-session and post-session levels of sAA were compared in both groups in response to therapy and control sessions.

RESULTS

In comparison to control sessions, occupational therapy significantly dampened rises in sAA levels while music therapy significantly decreased baseline sAA levels, highlighting the ability of both types of therapy to reduce stress and by proxy contribute to enhancing overall well-being.

CONCLUSIONS

Not only do these results confirm the stress-reducing nature of two types of multisensory therapy, but they support the use of sAA as a potential tool for evaluating stress levels in individuals with intellectual disability and autism spectrum disorder, providing an important physiological lens that may guide strategies in clinical and non-clinical care for individuals with disabilities.

Music and the brain - design of an MEG compatible piano

Magnetoencephalography (MEG) neuroimaging has been used to study subjects' responses when listening to music, but research into the effects of playing music has been limited by the lack of MEG compatible instruments that can operate in a magnetically shielded environment without creating electromagnetic interference. This paper describes the design and preliminary testing of an MEG compatible piano keyboard with 25 full size keys that employs a novel 3-state optical encoder design and electronics to provide realistic velocity-controlled volume modulation. This instrument will allow researchers to study musical performance on a finer timescale than fMRI and enable a range of MEG studies.

The Music Therapy Session Assessment Scale (MT-SAS): Validation of a new tool for music therapy process evaluation

BACKGROUND

Music therapy (MT) interventions are aimed at creating and developing a relationship between patient and therapist. However, there is a lack of validated observational instruments to consistently evaluate the MT process.

AIM

The purpose of this study was the validation of Music Therapy Session Assessment Scale (MT-SAS), designed to assess the relationship between therapist and patient during active MT sessions.

METHODS

Videotapes of a single 30-min session per patient were considered. A pilot study on the videotapes of 10 patients was carried out to help refine the items, define the scoring system and improve inter-rater reliability among the five raters. Then, a validation study on 100 patients with different clinical conditions was carried out. The Italian MT-SAS was used throughout the process, although we also provide an English translation.

RESULTS

The final scale consisted of 7 binary items accounting for eye contact, countenance, and nonverbal and sound-music communication. In the pilot study, raters were found to share an acceptable level of agreement in their assessments. Explorative factorial analysis disclosed a single homogeneous factor including 6 items (thus supporting an ordinal total score), with only the item about eye contact being unrelated to the others. Moreover, the existence of 2 different archetypal profiles of attuned and disattuned behaviours was highlighted through multiple correspondence analysis.

CONCLUSIONS

As suggested by the consistent results of 2 different analyses, MT-SAS is a reliable tool that globally evaluates sonorous-musical and nonverbal behaviours related to emotional attunement and empathetic relationship between patient and therapist during active MT sessions.

Social outcomes in children with autism spectrum disorder: a review of music therapy outcomes

Autism spectrum disorder (ASD) affects approximately one in 68 children, substantially affecting the child's ability to acquire social skills. The application of effective interventions to facilitate and develop social skills is essential due to the lifelong impact that social skills may have on independence and functioning. Research indicates that music therapy can improve social outcomes in children with ASD. Outcome measures are primarily assessed using standardized nonmusical scales of social functioning from the parent or clinician perspective. Certified music therapists may also assess musical engagement and outcomes as a part of the individual's profile. These measures provide an assessment of the individual's social functioning within the music therapy session and generalizability to nonmusical settings.

Music therapy microanalysis of parent-infant interaction in a three-month-old infant later diagnosed with autism

<b>Background</b><br /> Infant research literature has described for a long time the main aspects of parentese (motherese and fatherese) referring to musicality and specifically to musical language. It is believed that there is a deep analogy between the vital affects experienced by the child during interaction with the parent and the type of parentese that is a direct representation of them. Disruption of parentese has been described in early autism. The aim of this paper was to achieve a better understanding of this disruptive process.<br /> <br /> <b>Participants and procedure</b><br /> Sequences of parent-infant interaction extracted from one home movie of a child later diagnosed with autism were analyzed in a micro-musical way in order to create a musical score that allows the description of parent-infant interaction in a new way (considering form, pulse, rhythm, melody, timbre and silence).<br /> <br /> <b>Results</b><br /> Musical microanalysis is able to highlight features not brought out by other kinds of analysis. The first fragment is dominated by the anxiety of the mother, who attempts to stimulate the unresponsive infant. In the second fragment there is a change in musicality parallel to changes in the relationship: the mother participates in and coordinates the infant’s experience through rhythm, prosody and musical dynamics. This change persists in the third fragment.<br /> <br /> <b>Conclusions</b><br /> Musical transcription of parent-infant interactions has allowed us to highlight changes occurring in a short time during early interactions and to get a closer view of the disruptive process created by autism. This kind of research represents a potential shift in autism research, by focusing on dynamic parent-infant interactions instead of single behaviors of the child or of the parent. The usefulness of Stern’s concept of intersubjective communion is discussed.

KAMUTHE video microanalysis system for use in Brazil: translation, cross-cultural adaptation and evidence of validity and reliability

<b>Background</b><br /> KAMUTHE is a video microanalysis system which observes preverbal communication within the music therapy setting. This system is indicated for children with autism spectrum disorder (ASD) or multiple disabilities. The purpose of this study was to translate, adapt to Brazilian Portuguese language and analyze some psychometric properties (reliability and validity evidence) of KAMUTHE administration in Brazil for individuals with ASD.<br /> <br /> <b>Participants and procedure</b><br /> Translation, back translation, analysis by judges, and pilot application were performed to obtain evidence of content and face validity. The second part of this study was to administer KAMUTHE in 39 consecutive children with ASD. An individual session of improvisational music therapy was applied to assess the different behaviors included in KAMUTHE. The intra-rater reliability, concurrent validity and convergent validity were analyzed.<br /> <br /> <b>Results</b><br /> Translation and cross-cultural adaptation were followed and some cultural adaptations were needed. Inter-rater reliability was very good (ICCs 0.95-0.99) for the three child’s behaviors analyzed. Criteria validity with a moderate negative association was found (r = –.38, p = .017) comparing the behavior “Gazes at therapist” and the level of ASD along with the Childhood Autism Rating Scale (CARS). Convergent validity was established between the behavior “Gazes at therapist” and the two nonlinguistic communication scales (social interaction and interests) of the Children’s Communication Checklist (CCC) with a moderate correlation (r = –.43, p = .005).<br /> <br /> <b>Conclusions</b><br /> The administration of the KAMUTHE video microanalysis system showed positive results in children with ASD. Further studies are needed to improve the reliability and validity of the instrument in Brazil.

Music application alleviates short-term memory impairments through increasing cell proliferation in the hippocampus of valproic acid-induced autistic rat pups

Autism is a neurodevelopmental disorder and this disorder shows impairment in reciprocal social interactions, deficits in communication, and restrictive and repetitive patterns of behaviors and interests. The effect of music on short-term memory in the view of cell proliferation in the hippocampus was evaluated using valproic acid-induced autistic rat pups. Animal model of autism was made by subcutaneous injection of 400-mg/kg valproic acid into the rat pups on the postnatal day 14. The rat pups in the music-applied groups were exposed to the 65-dB comfortable classic music for 1 hr once a day, starting postnatal day 15 and continued until postnatal day 28. In the present results, short-term memory was deteriorated by autism induction. The numbers of 5-bromo-2'-deoxyridine (BrdU)-positive, Ki-67-positive, and doublecortin (DCX)-positive cells in the hippocampal dentate gyrus were decreased by autism induction. Brain-derived neurotrophic factor (BDNF) and tyrosine kinase B (TrkB) expressions in the hippocampus were also suppressed in the autistic rat pups. Music application alleviated short-term memory deficits with enhancing the numbers of BrdU-positive, Ki-67-positive, and DCX-positive cells in the autistic rat pups. Music application also enhanced BDNF and TrkB expressions in the autistic rat pups. The present study show that application of music enhanced hippocampal cell proliferation and alleviated short-term memory impairment through stimulating BDNF-TrkB signaling in the autistic rat pups. Music can be suggested as the therapeutic strategy to overcome the autism-induced memory deficits.

Analysing change in music therapy interactions of children with communication difficulties

Music therapy has been found to improve communicative behaviours and joint attention in children with autism, but it is unclear what in the music therapy sessions drives those changes. We developed an annotation protocol and tools to accumulate large datasets of music therapy, for analysis of interaction dynamics. Analysis of video recordings of improvisational music therapy sessions focused on simple, unambiguous individual and shared behaviours: movement and facing behaviours, rhythmic activity and musical structures and the relationships between them. To test the feasibility of the protocol, early and late sessions of five client-therapist pairs were annotated and analysed to track changes in behaviours. To assess the reliability and validity of the protocol, inter-rater reliability of the annotation tiers was calculated, and the therapists provided feedback about the relevance of the analyses and results. This small-scale study suggests that there are both similarities and differences in the profiles of client-therapist sessions. For example, all therapists faced the clients most of the time, while the clients did not face back so often. Conversely, only two pairs had an increase in regular pulse from early to late sessions. More broadly, similarity across pairs at a general level is complemented by variation in the details. This perhaps goes some way to reconciling client- and context-specificity on one hand and generalizability on the other. Behavioural characteristics seem to influence each other. For instance, shared rhythmic pulse alternated with mutual facing and the occurrence of shared pulse was found to relate to the musical structure. These observations point towards a framework for looking at change in music therapy that focuses on networks of variables or broader categories. The results suggest that even when starting with simple behaviours, we can trace aspects of interaction and change in music therapy, which are seen as relevant by therapists.

Social functioning and autonomic nervous system sensitivity across vocal and musical emotion in Williams syndrome and autism spectrum disorder

Both Williams syndrome (WS) and autism spectrum disorders (ASD) are associated with unusual auditory phenotypes with respect to processing vocal and musical stimuli, which may be shaped by the atypical social profiles that characterize the syndromes. Autonomic nervous system (ANS) reactivity to vocal and musical emotional stimuli was examined in 12 children with WS, 17 children with ASD, and 20 typically developing (TD) children, and related to their level of social functioning. The results of this small-scale study showed that after controlling for between-group differences in cognitive ability, all groups showed similar emotion identification performance across conditions. Additionally, in ASD, lower autonomic reactivity to human voice, and in TD, to musical emotion, was related to more normal social functioning. Compared to TD, both clinical groups showed increased arousal to vocalizations. A further result highlighted uniquely increased arousal to music in WS, contrasted with a decrease in arousal in ASD and TD. The ASD and WS groups exhibited arousal patterns suggestive of diminished habituation to the auditory stimuli. The results are discussed in the context of the clinical presentation of WS and ASD.

A comparison of the effects of rhythm and robotic interventions on repetitive behaviors and affective states of children with Autism Spectrum Disorder (ASD)

Repetitive behaviors and poor affect regulation are commonly seen in children with Autism Spectrum Disorder (ASD). We compared the effects of two novel interventions - rhythm and robotic therapies, with those of a standard-of-care intervention, on the repetitive behaviors and affective states of 36 children with ASD between 5 and 12 years using a randomized controlled trial design. We coded for frequencies of sensory, negative, and stereotyped behaviors and the duration of positive, negative, and interested affective states in children during early, mid, and late training sessions. In terms of repetitive behaviors, in the early session, the rhythm and robot groups engaged in greater negative behaviors, whereas the comparison group engaged in greater sensory behaviors. With training, the rhythm group reduced negative behaviors whereas there were no training-related changes in the other groups. In terms of affective states, the rhythm and robot groups showed greater negative affect, whereas the comparison group demonstrated greater interested affect across all sessions. With training, the rhythm group showed a reduction in negative affect and an increase in interested affect whereas the robot group showed a reduction in positive affect. Overall, it appears that rhythm-based interventions are socially engaging treatment tools to target core impairments in autism.

Concepts of context in music therapy

In contemporary music therapy as well as in related interdisciplinary fields, the importance of context in relation to theory, research, and practice has been emphasized. However, the word context seems to be used in several different ways and conceptualizations of contextual approaches vary too. The objective of this theoretical article is to clarify traditions of language use in relation to context in music therapy. In reviewing and discussing the literature, we focus on the field of mental health care. When discussing issues related to context, this literature partly focuses on the surroundings of music therapy practice, partly on the ecology of reciprocal influences within and between situations or systems. On this basis, three types of context awareness in music therapy are identified: music therapy in context; music therapy as context; and music therapy as interacting contexts. The identified types of context awareness are exemplified through references to music therapy literature and then discussed in relation to two very different metaphors, namely context as frame and context as link. Implications for practice, research, and theory development in music therapy are suggested.

Music therapy for people with autism spectrum disorder

BACKGROUND

The central impairments of people with autism spectrum disorder (ASD) affect social interaction and communication. Music therapy uses musical experiences and the relationships that develop through them to enable communication and expression, thus attempting to address some of the core problems of people with ASD. The present version of this review on music therapy for ASD is an update of the original Cochrane review published in 2006.

OBJECTIVES

To assess the effects of music therapy for individuals with ASD.

SEARCH METHODS

We searched the following databases in July 2013: CENTRAL, Ovid MEDLINE, EMBASE, LILACS, PsycINFO, CINAHL, ERIC, ASSIA, Sociological Abstracts, and Dissertation Abstracts International. We also checked the reference lists of relevant studies and contacted investigators in person.

SELECTION CRITERIA

All randomised controlled trials (RCTs) or controlled clinical trials comparing music therapy or music therapy added to standard care to 'placebo' therapy, no treatment, or standard care for individuals with ASD were considered for inclusion.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated the pooled standardised mean difference (SMD) and corresponding 95% confidence interval (CI) for continuous outcomes to allow the combination data from different scales and to facilitate the interpretation of effect sizes. Heterogeneity was assessed using the I² statistic. In cases of statistical heterogeneity within outcome subgroups, we examined clients' age, intensity of therapy (number and frequency of therapy sessions), and treatment approach as possible sources of heterogeneity.

MAIN RESULTS

We included 10 studies (165 participants) that examined the short- and medium-term effect of music therapy interventions (one week to seven months) for children with ASD. Music was superior to 'placebo' therapy or standard care with respect to the primary outcomes social interaction within the therapy context (SMD 1.06, 95% CI 0.02 to 2.10, 1 RCT, n = 10); generalised social interaction outside of the therapy context (SMD 0.71, 95% CI 0.18 to 1.25, 3 RCTs, n = 57, moderate quality evidence), non-verbal communicative skills within the therapy context (SMD 0.57, 95% CI 0.29 to 0.85, 3 RCTs, n = 30), verbal communicative skills (SMD 0.33, 95% CI 0.16 to 0.49, 6 RCTs, n = 139), initiating behaviour (SMD 0.73, 95% CI 0.36 to 1.11, 3 RCTs, n = 22, moderate quality evidence), and social-emotional reciprocity (SMD 2.28, 95% CI 0.73 to 3.83, 1 RCT, n = 10, low quality evidence). There was no statistically significant difference in non-verbal communicative skills outside of the therapy context (SMD 0.48, 95% CI -0.02 to 0.98, 3 RCTs, n = 57, low quality evidence). Music therapy was also superior to 'placebo' therapy or standard care in secondary outcome areas, including social adaptation (SMD 0.41, 95% CI 0.21 to 0.60, 4 RCTs, n = 26), joy (SMD 0.96, 95% CI 0.04 to 1.88, 1 RCT, n = 10), and quality of parent-child relationships (SMD 0.82, 95% CI 0.13 to 1.52, 2 RCTs, n = 33, moderate quality evidence). None of the included studies reported any adverse effects. The small sample sizes of the studies limit the methodological strength of these findings.

AUTHORS' CONCLUSIONS

The findings of this updated review provide evidence that music therapy may help children with ASD to improve their skills in primary outcome areas that constitute the core of the condition including social interaction, verbal communication, initiating behaviour, and social-emotional reciprocity. Music therapy may also help to enhance non-verbal communication skills within the therapy context. Furthermore, in secondary outcome areas, music therapy may contribute to increasing social adaptation skills in children with ASD and to promoting the quality of parent-child relationships. In contrast to the studies included in an earlier version of this review published in 2006, the new studies included in this update enhanced the applicability of findings to clinical practice. More research using larger samples and generalised outcome measures is needed to corroborate these findings and to examine whether the effects of music therapy are enduring. When applying the results of this review to practice, it is important to note that the application of music therapy requires specialised academic and clinical training.

Autism as a developmental disorder in intentional movement and affective engagement

We review evidence that autistic spectrum disorders have their origin in early prenatal failure of development in systems that program timing, serial coordination and prospective control of movements, and that regulate affective evaluations of experiences. There are effects in early infancy, before medical diagnosis, especially in motor sequencing, selective or exploratory attention, affective expression and intersubjective engagement with parents. These are followed by retardation of cognitive development and language learning in the second or third year, which lead to a diagnosis of ASD. The early signs relate to abnormalities that have been found in brain stem systems and cerebellum in the embryo or early fetal stage, before the cerebral neocortex is functional, and they have clear consequences in infancy when neocortical systems are intensively elaborated. We propose, with evidence of the disturbances of posture, locomotion and prospective motor control in children with autism, as well as of their facial expression of interest and affect, and attention to other persons' expressions, that examination of the psychobiology of motor affective disorders, rather than later developing cognitive or linguistic ones, may facilitate early diagnosis. Research in this area may also explain how intense interaction, imitation or "expressive art" therapies, which respond intimately with motor activities, are effective at later stages. Exceptional talents of some autistic people may be acquired compensations for basic problems with expectant self-regulations of movement, attention and emotion.

Embodiment and sense-making in autism

In this article, I sketch an enactive account of autism. For the enactive approach to cognition, embodiment, experience, and social interaction are fundamental to understanding mind and subjectivity. Enaction defines cognition as sense-making: the way cognitive agents meaningfully connect with their world, based on their needs and goals as self-organizing, self-maintaining, embodied agents. In the social realm, the interactive coordination of embodied sense-making activities with others lets us participate in each other's sense-making (social understanding = participatory sense-making). The enactive approach provides new concepts to overcome the problems of traditional functionalist accounts of autism, which can only give a piecemeal and disintegrated view because they consider cognition, communication, and perception separately, do not take embodied into account, and are methodologically individualistic. Applying the concepts of enaction to autism, I show: How embodiment and sense-making connect, i.e., how autistic particularities of moving, perceiving, and emoting relate to how people with autism make sense of their world. For instance, restricted interests or preference for detail will have certain sensorimotor correlates, as well as specific meaning for autistic people.That reduced flexibility in interactional coordination correlates with difficulties in participatory sense-making. At the same time, seemingly irrelevant "autistic behaviors" can be quite attuned to the interactive context. I illustrate this complexity in the case of echolalia. An enactive account of autism starts from the embodiment, experience, and social interactions of autistic people. Enaction brings together the sensorimotor, cognitive, social, experiential, and affective aspects of autism in a coherent framework based on a complex non-linear multi-causality. This foundation allows to build new bridges between autistic people and their often non-autistic context, and to improve quality of life prospects.

A review of complementary and alternative treatments for autism spectrum disorders

Given the severe and chronic problems associated with Autism Spectrum Disorders (ASD) and the limitations of available treatments, there exists a large public health need for additional interventions. As more parents are inquiring about complementary and alternative treatments (CATs), both parents and practitioners require up-to-date information about them and whether and how to integrate them into treatment. After presenting data on CAT usage patterns for ASD, we review 13 ingestible (i.e., orally administered) and 6 noningestible (i.e., externally administered) CATs for ASD. For each CAT we briefly describe its definition; rationale for use; current research support, limitations, and future directions; safety issues; and whether we currently recommend, not recommend, or find it acceptable for the treatment of ASD. We conclude this paper with recommendations for future research and ten clinical recommendations for practitioners.

Functional improvement and social participation through sports activity for children with mental retardation: a field study from a developing nation

BACKGROUND

While the positive effect of sports and exercise on physical and psychological well being is well documented within the general population, the effects of sports on the functional ability of a child with mental retardation are limited.

OBJECTIVES

To determine if sports activities have been detrimental in improving functional ability in sample of children with mental retardation based in Kolkata, a metropolis in India.

STUDY DESIGN

Field level study.

METHODS

Six sports associations registered under the Sports Authority of India for training children with mental retardation were shortlisted on the basis of four criteria. From the register, every third name (gender irrespective) belonging to the second (12-15 years) and third (15-21 years) subclasses (out of the four categories laid down in the Special Olympics participation rules) against a constraint of at least two years active attendance in the sports facility for the child was selected. A sample of 31 children was drawn and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version was administered to the caregiver-teacher-coach team of the sample. Relative changes in scores between the point when the survey was conducted and the point when the child joined the sports facility was used as the dependent variable for regression analysis. The number of years in active sports, in school age of the respondent and base score of the children when they joined school were the independent variables.

RESULTS

For seven of the WHODAS 2.0 12-item attributes, the number of years in sports activities was found to have a statistically significant effect (p < 0.01) on the functional well being of children with mild to moderate mental retardation. The number of years in school was also another statistically significant factor (p < 0.01) responsible for this improvement. The children, however, perceived of being not welcome in community activities, but participated in activities meant exclusively for them.

CONCLUSIONS

This small study showed that the proposition that number of years in sports activities was a significant factor responsible for improving the functioning of children with mild to moderate mental retardation.

Neural systems for speech and song in autism

Despite language disabilities in autism, music abilities are frequently preserved. Paradoxically, brain regions associated with these functions typically overlap, enabling investigation of neural organization supporting speech and song in autism. Neural systems sensitive to speech and song were compared in low-functioning autistic and age-matched control children using passive auditory stimulation during functional magnetic resonance and diffusion tensor imaging. Activation in left inferior frontal gyrus was reduced in autistic children relative to controls during speech stimulation, but was greater than controls during song stimulation. Functional connectivity for song relative to speech was also increased between left inferior frontal gyrus and superior temporal gyrus in autism, and large-scale connectivity showed increased frontal–posterior connections. Although fractional anisotropy of the left arcuate fasciculus was decreased in autistic children relative to controls, structural terminations of the arcuate fasciculus in inferior frontal gyrus were indistinguishable between autistic and control groups. Fractional anisotropy correlated with activity in left inferior frontal gyrus for both speech and song conditions. Together, these findings indicate that in autism, functional systems that process speech and song were more effectively engaged for song than for speech and projections of structural pathways associated with these functions were not distinguishable from controls.

Randomised controlled trial of improvisational music therapy's effectiveness for children with autism spectrum disorders (TIME-A): study protocol

Background

Previous research has suggested that music therapy may facilitate skills in areas typically affected by autism spectrum disorders such as social interaction and communication. However, generalisability of previous findings has been restricted, as studies were limited in either methodological accuracy or the clinical relevance of their approach. The aim of this study is to determine effects of improvisational music therapy on social communication skills of children with autism spectrum disorders. An additional aim of the study is to examine if variation in dose of treatment (i.e., number of music therapy sessions per week) affects outcome of therapy, and to determine cost-effectiveness.

Methods/Design

Children aged between 4;0 and 6;11 years who are diagnosed with autism spectrum disorder will be randomly assigned to one of three conditions. Parents of all participants will receive three sessions of parent counselling (at 0, 2, and 5 months). In addition, children randomised to the two intervention groups will be offered individual, improvisational music therapy over a period of five months, either one session (low-intensity) or three sessions (high-intensity) per week. Generalised effects of music therapy will be measured using standardised scales completed by blinded assessors (Autism Diagnostic Observation Schedule, ADOS) and parents (Social Responsiveness Scale, SRS) before and 2, 5, and 12 months after randomisation. Cost effectiveness will be calculated as man years. A group sequential design with first interim look at N = 235 will ensure both power and efficiency.

Discussion

Responding to the need for more rigorously designed trials examining the effectiveness of music therapy in autism spectrum disorders, this pragmatic trial sets out to generate findings that will be well generalisable to clinical practice. Addressing the issue of dose variation, this study's results will also provide information on the relevance of session frequency for therapy outcome.

Trial Registration

Current Controlled Trials ISRCTN78923965.

Effects of music therapy on mood in stroke patients

PURPOSE

To investigate the effects of music therapy on depressive mood and anxiety in post-stroke patients and evaluate satisfaction levels of patients and caregivers.

MATERIALS AND METHODS

Eighteen post-stroke patients, within six months of onset and mini mental status examination score of over 20, participated in this study. Patients were divided into music and control groups. The experimental group participated in the music therapy program for four weeks. Psychological status was evaluated with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) before and after music therapy. Satisfaction with music therapy was evaluated by a questionnaire.

RESULTS

BAI and BDI scores showed a greater decrease in the music group than the control group after music therapy, but only the decrease of BDI scores were statistically significant (p=0.048). Music therapy satisfaction in patients and caregivers was affirmative.

CONCLUSION

Music therapy has a positive effect on mood in post-stroke patients and may be beneficial for mood improvement with stroke. These results are encouraging, but further studies are needed in this field.

Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders

Autism spectrum disorders (ASDs) are the most common pediatric diagnoses in the United States. In this perspective article, we propose that a diverse set of motor impairments are present in children and adults with ASDs. Specifically, we will discuss evidence related to gross motor, fine motor, postural control, and imitation/praxis impairments. Moreover, we propose that early motor delays within the first 2 years of life may contribute to the social impairments of children with ASDs; therefore, it is important to address motor impairments through timely assessments and effective interventions. Lastly, we acknowledge the limitations of the evidence currently available and suggest clinical implications for motor assessment and interventions in children with ASDs. In terms of assessment, we believe that comprehensive motor evaluations are warranted for children with ASDs and infants at risk for ASDs. In terms of interventions, there is an urgent need to develop novel embodied interventions grounded in movement and motor learning principles for children with autism.