The case for treatment fidelity in active music interventions: why and how

Music, drama, and social development in Portuguese children

Introduction

Social competence plays a fundamental role in children's development, and in their functioning at school and in life. Social skills, as learned behaviors that allow children to positively interact with others, are important for success in both academic and peer-group settings. Children's participation in collective music and other arts education has been associated with the development of social skills. However, different measures and diverse programs adopted in various studies make it difficult to contrast study findings. Additionally, research with children from low-income families remains scarce. The aim of this study was to examine the role of music and drama education programs in primary schools on the development of social skills of Portuguese children from disadvantaged communities. Both programs were carefully designed with performing, creating, and listening activities, and were delivered by specialist and experienced teachers/performers, who used active and participatory teaching strategies.

Methods

In our longitudinal design with pre- and post-evaluations, we used the Social Skills Rating System or SSRS-Teacher Form, adapted for the Portuguese population. Classroom teachers rated their students' social skills on a 3-point scale in three domains: Social skills (Cooperation, Assertion, Self-control), Behavioral problems (Externalizing problems, Internalizing problems, Hyperactivity) and, on a 5-point scale, Academic competence.

Results and Discussion

Our findings suggest that participation in music and drama programs during one school year improved children's assertion and self-control, and cooperation in the drama group. Participation in the music and drama programs also appeared to serve as a protective factor by reducing externalizing, internalizing and behavioral problems. These findings are discussed in light of previous studies along with limitations and directions for future research.

Musical groove shapes children's free dancing

The drive to move to music is evident across a variety of contexts, from the simple urge to tap our toe to a song on the radio, to massive crowds dancing in time at a rock concert. Though seemingly effortless, beat synchronization is difficult to master and children are often poor beat synchronizers. Nevertheless, auditory-motor integration is fundamental for many daily processes, such as speech. A topic that has been relatively understudied concerns how stimulus properties affect young children's movement in responses to auditory stimuli. In the present study, we examined how musical groove (adult-rated desire to move) affected 3.0- to 6.9-year-old children's free dancing in the comfort of their home (n = 78). In the high groove conditions, children danced more and with more energy compared to the low groove conditions. Moreover, in the high groove condition, children's movement tempos corresponded better with the tempos of the music. Results point to early childhood sensitivity to the musical features that motivate adults to move to music. High groove music may therefore prove especially effective at facilitating early auditory-motor integration. A video abstract of this article can be viewed at https://youtu.be/vli0-6N12Ts.

Implementing NIH Behavior Change Consortium Treatment Fidelity Recommendations in a Multi-Site Randomized Controlled Trial of an Active Music Engagement Intervention for Young Children with Cancer and Parents

Treatment fidelity is the use of methodological strategies to monitor and enhance reliability and validity of behavioral intervention trials. Despite availability of guidelines and checklists, treatment fidelity remains underreported, hindering evaluation, interpretation, and cross-study comparisons. Treatment fidelity is particularly important for music interventions given the inherent complexity of musical stimuli and flexibility required for tailored delivery. The purpose of this paper is to define and describe treatment fidelity strategies for our trial of a music-based play intervention for young children with cancer and parents grounded in the NIH Behavior Change Consortium Treatment Fidelity Recommendations. We report strategies for all 5 areas: study design, training providers, delivery of treatment, receipt of treatment, and enactment of treatment skills. We also discuss 4 challenges our team encountered, including: (1) standardizing live music delivery, (2) defining boundaries for tailored intervention delivery, (3) managing extended time between participants, and (4) minimizing risk for bias. This paper expands on current fidelity literature and may provide a working model for other investigators examining dyadic and/or active music interventions.

Music-based interventions in community settings: Navigating the tension between rigor and ecological validity

Empirical research of community-based music interventions has advanced to investigate the individual, social, and educational implications of arts-for-wellbeing practices. Here, we present the motivations, aims, hypotheses, and implications of this complex field of inquiry. We describe examples of recent large-scale investigations to reflect on the major methodological challenges. Community-based music interventions strike a balance between the empirical rigor of clinical trials and the demands of ecological validity. We argue that this balance should be viewed as an asset rather than a mere pragmatic compromise. We also offer some perspectives on best-practice models for effectively engaging in this type of work.

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.

Processing rhythm in speech and music: Shared mechanisms and implications for developmental speech and language disorders

OBJECTIVE

Music and speech are complex signals containing regularities in how they unfold in time. Similarities between music and speech/language in terms of their auditory features, rhythmic structure, and hierarchical structure have led to a large body of literature suggesting connections between the two domains. However, the precise underlying mechanisms behind this connection remain to be elucidated.

METHOD

In this theoretical review article, we synthesize previous research and present a framework of potentially shared neural mechanisms for music and speech rhythm processing. We outline structural similarities of rhythmic signals in music and speech, synthesize prominent music and speech rhythm theories, discuss impaired timing in developmental speech and language disorders, and discuss music rhythm training as an additional, potentially effective therapeutic tool to enhance speech/language processing in these disorders.

RESULTS

We propose the processing rhythm in speech and music (PRISM) framework, which outlines three underlying mechanisms that appear to be shared across music and speech/language processing: Precise auditory processing, synchronization/entrainment of neural oscillations to external stimuli, and sensorimotor coupling. The goal of this framework is to inform directions for future research that integrate cognitive and biological evidence for relationships between rhythm processing in music and speech.

CONCLUSION

The current framework can be used as a basis to investigate potential links between observed timing deficits in developmental disorders, impairments in the proposed mechanisms, and pathology-specific deficits which can be targeted in treatment and training supporting speech therapy outcomes. On these grounds, we propose future research directions and discuss implications of our framework. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

Auditory Stimulation Training With Technically Manipulated Musical Material in Preschool Children With Specific Language Impairments: An Explorative Study

Auditory stimulation training (AST) has been proposed as a potential treatment for children with specific language impairments (SLI). The current study was designed to test this assumption by using an AST with technically modulated musical material (ASTM) in a randomized control group design. A total of 101 preschool children (62 male, 39 females; mean age = 4.52 years, SD = 0.62) with deficits in speech comprehension and poor working memory capacity were randomly allocated into one of two treatment groups or a control group. Children in the ASTM group (n = 40) received three 30-min sessions per week over 12 weeks, whereas children in the comparison group received pedagogical activities during these intervals (n = 24). Children in the control group (n = 37) received no treatment. Working memory, phoneme discrimination and speech perception skills were tested prior to (baseline) and after treatment. Children in the ASTM group showed significantly greater working memory capacity, speech perception, and phoneme discrimination skills after treatment, whereas children in the other groups did not show such improvement. Taken together, these results suggest that ASTM can enhance auditory cognitive performance in children with SLI.

Music improves social communication and auditory-motor connectivity in children with autism

Music has been identified as a strength in people with Autism Spectrum Disorder; however, there is currently no neuroscientific evidence supporting its benefits. Given its universal appeal, intrinsic reward value and ability to modify brain and behaviour, music may be a potential therapeutic aid in autism. Here we evaluated the neurobehavioural outcomes of a music intervention, compared to a non-music control intervention, on social communication and brain connectivity in school-age children (ISRCTN26821793). Fifty-one children aged 6-12 years with autism were randomized to receive 8-12 weeks of music (n = 26) or non-music intervention (n = 25). The music intervention involved use of improvisational approaches through song and rhythm to target social communication. The non-music control was a structurally matched behavioural intervention implemented in a non-musical context. Groups were assessed before and after intervention on social communication and resting-state functional connectivity of fronto-temporal brain networks. Communication scores were higher in the music group post-intervention (difference score = 4.84, P = .01). Associated post-intervention resting-state brain functional connectivity was greater in music vs. non-music groups between auditory and subcortical regions (z = 3.94, P < .0001) and auditory and fronto-motor regions (z = 3.16, P < .0001). Post-intervention brain connectivity was lower between auditory and visual regions in the music compared to the non-music groups, known to be over-connected in autism (z = 4.01, P < .00001). Post-intervention brain connectivity in the music group was related to communication improvement (z = 3.57, P < .0001). This study provides the first evidence that 8-12 weeks of individual music intervention can indeed improve social communication and functional brain connectivity, lending support to further investigations of neurobiologically motivated models of music interventions in autism.