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Williams TI, Loucas T, Sin J, Jeremic M, Meyer S, Boseley S, Fincham-Majumdar S, Aslett G, Renshaw R, Liu F. Using music to assist language learning in autistic children with minimal verbal language: The MAP feasibility RCT. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241233804. [PMID: 38433533 DOI: 10.1177/13623613241233804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
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.
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Feng H, Mahoor MH, Dino F. A Music-Therapy Robotic Platform for Children With Autism: A Pilot Study. Front Robot AI 2022; 9:855819. [PMID: 35677082 PMCID: PMC9169087 DOI: 10.3389/frobt.2022.855819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Children with Autism Spectrum Disorder (ASD) experience deficits in verbal and nonverbal communication skills including motor control, turn-taking, and emotion recognition. Innovative technology, such as socially assistive robots, has shown to be a viable method for Autism therapy. This paper presents a novel robot-based music-therapy platform for modeling and improving the social responses and behaviors of children with ASD. Our autonomous social interactive system consists of three modules. Module one provides an autonomous initiative positioning system for the robot, NAO, to properly localize and play the instrument (Xylophone) using the robot’s arms. Module two allows NAO to play customized songs composed by individuals. Module three provides a real-life music therapy experience to the users. We adopted Short-time Fourier Transform and Levenshtein distance to fulfill the design requirements: 1) “music detection” and 2) “smart scoring and feedback”, which allows NAO to understand music and provide additional practice and oral feedback to the users as applicable. We designed and implemented six Human-Robot-Interaction (HRI) sessions including four intervention sessions. Nine children with ASD and seven Typically Developing participated in a total of fifty HRI experimental sessions. Using our platform, we collected and analyzed data on social behavioral changes and emotion recognition using Electrodermal Activity (EDA) signals. The results of our experiments demonstrate most of the participants were able to complete motor control tasks with 70% accuracy. Six out of the nine ASD participants showed stable turn-taking behavior when playing music. The results of automated emotion classification using Support Vector Machines illustrates that emotional arousal in the ASD group can be detected and well recognized via EDA bio-signals. In summary, the results of our data analyses, including emotion classification using EDA signals, indicate that the proposed robot-music based therapy platform is an attractive and promising assistive tool to facilitate the improvement of fine motor control and turn-taking skills in children with ASD.
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Affiliation(s)
| | - Mohammad H. Mahoor
- Computer Vision and Social Robotics Labarotory, Department of Electrical and Computer Engineering, University of Denver, Denver, CO, United States
- *Correspondence: Mohammad H. Mahoor,
| | - Francesca Dino
- Computer Vision and Social Robotics Labarotory, Department of Electrical and Computer Engineering, University of Denver, Denver, CO, United States
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Abstract
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.
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Affiliation(s)
- Monika Geretsegger
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Cochavit Elefant
- Department of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Karin A Mössler
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | - Giovanni Vitale
- Child and Adolescent Neuropsychiatry, University of Naples Federico II, Naples, Italy
| | - Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
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Rickson D. Family members’ and other experts’ perceptions of music therapy with children on the autism spectrum in New Zealand: Findings from multiple case studies. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2021.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Latif N, Di Francesco C, Custo-Blanch M, Hyde K, Sharda M, Nadig A. Joint engagement and movement: Active ingredients of a music-based intervention with school-age children with autism. NeuroRehabilitation 2021; 48:167-185. [PMID: 33664155 DOI: 10.3233/nre-208012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Nida Latif
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
| | - Cynthia Di Francesco
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada
| | - Melanie Custo-Blanch
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
| | - Krista Hyde
- International Laboratory for Brain, Music and Sound Research (BRAMS), Department of Psychology, Université de Montréal, Pavillon Marie-Victorin, Montreal, Canada
| | - Megha Sharda
- International Laboratory for Brain, Music and Sound Research (BRAMS), Department of Psychology, Université de Montréal, Pavillon Marie-Victorin, Montreal, Canada
| | - Aparna Nadig
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
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Morris PO, Hope E, Foulsham T, Mills JP. Dance, rhythm, and autism spectrum disorder: An explorative study. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2020.101755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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The Effectiveness of Mirroring- and Rhythm-Based Interventions for Children with Autism Spectrum Disorder: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00236-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Delafield-Butt JT, Zeedyk MS, Harder S, Vaever MS, Caldwell P. Making Meaning Together: Embodied Narratives in a Case of Severe Autism. Psychopathology 2020; 53:60-73. [PMID: 32422641 PMCID: PMC8619765 DOI: 10.1159/000506648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
Shared understanding is generated between individuals before speech through a language of body movement and non-verbal vocalisation, expression of feeling and interest made in gestures of movement and voice. Human understanding is co-created in these embodied projects, displayed in serially organised expressions with shared timing of reciprocal actions between partners. These develop in narrative events that build over cycles of reciprocal expressive action in a four-part structure shared by all the time-based arts: "introduction," "development," "climax," and "conclusion." Pre-linguistic narrative establishes the foundation of later, linguistic intelligence. Yet, participating in social interactions that give rise to narrative development is a central problem of autism spectrum disorder. In this paper, we examine the rapid growth of narrative meaning-making between a non-verbal young woman with severe autism and her new therapist. Episodes of embodied, shared understanding were enabled through a basic therapeutic mode of reciprocal, creative mirroring of expressive gesture. These developed through reciprocal cycles and as the relationship progressed, complete co-created narratives were formed resulting in shared joy and the mutual interest and trust of companionship. These small, embodied stories enabled moments of co-regulated arousal that the young woman had previous difficulty with. These data provide evidence for an intact capacity for non-verbal narrative meaning-making in autism.
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Affiliation(s)
| | - M Suzanne Zeedyk
- School of Psychology, University of Dundee, Dundee, United Kingdom
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Mette S Vaever
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Phoebe Caldwell
- Private Practitioner, Beechstones Barn, Lancaster, United Kingdom
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Bharathi G, Venugopal A, Vellingiri B. Music therapy as a therapeutic tool in improving the social skills of autistic children. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0091-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Srinivasan SM, Eigsti IM, Neelly L, Bhat AN. The effects of embodied rhythm and robotic interventions on the spontaneous and responsive social attention patterns of children with Autism Spectrum Disorder (ASD): A pilot randomized controlled trial. RESEARCH IN AUTISM SPECTRUM DISORDERS 2016; 27:54-72. [PMID: 27453721 PMCID: PMC4955647 DOI: 10.1016/j.rasd.2016.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
We compared the effects of 8-weeks of rhythm and robotic interventions with those of a comparison, standard-of-care intervention, on the spontaneous and responsive social attention patterns of school-age children with Autism Spectrum Disorder. Attention patterns were examined within a standardized pretest/posttest measure of joint attention (JA) and a training-specific social attention measure during early, mid, and late training sessions. The rhythm and comparison groups demonstrated improvements in JA. Social attention was greater in the rhythm followed by the robot and lastly the comparison group. The robot and comparison groups spent maximum time fixating on the robot and objects, respectively. Across sessions, the robot group decreased attention to the robot and increased attention to elsewhere. Overall, rhythmic movement contexts afford sustained social monitoring in children with autism.
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Affiliation(s)
- Sudha M. Srinivasan
- Department of Physical Therapy, Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, USA
| | - Inge-Marie Eigsti
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Linda Neelly
- Neag School of Education & School of Music, University of Connecticut, Storrs, CT, USA
| | - Anjana N. Bhat
- Department of Physical Therapy, Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, USA
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Neag School of Education & School of Music, University of Connecticut, Storrs, CT, USA
- Center for Health, Intervention, and Prevention, Department of Psychology, University of Connecticut, Storrs, CT, USA
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The Effects of Rhythm and Robotic Interventions on the Imitation/Praxis, Interpersonal Synchrony, and Motor Performance of Children with Autism Spectrum Disorder (ASD): A Pilot Randomized Controlled Trial. AUTISM RESEARCH AND TREATMENT 2015; 2015:736516. [PMID: 26793394 PMCID: PMC4697072 DOI: 10.1155/2015/736516] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/06/2015] [Accepted: 11/26/2015] [Indexed: 12/12/2022]
Abstract
We assessed the effects of three interventions, rhythm, robotic, and standard-of-care, on the imitation/praxis, interpersonal synchrony, and overall motor performance of 36 children with Autism Spectrum Disorder (ASD) between 5 and 12 years of age. Children were matched on age, level of functioning, and services received, prior to random assignment to one of the three groups. Training was provided for 8 weeks with 4 sessions provided each week. We assessed generalized changes in motor skills from the pretest to the posttest using a standardized test of motor performance, the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2). We also assessed training-specific changes in imitation/praxis and interpersonal synchrony during an early and a late session. Consistent with the training activities practiced, the rhythm and robot groups improved on the body coordination composite of the BOT-2, whereas the comparison group improved on the fine manual control composite of the BOT-2. All three groups demonstrated improvements in imitation/praxis. The rhythm and robot groups also showed improved interpersonal synchrony performance from the early to the late session. Overall, socially embedded movement-based contexts are valuable in promoting imitation/praxis, interpersonal synchrony, and motor performance and should be included within the standard-of-care treatment for children with ASD.
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Srinivasan SM, Park IK, Neelly LB, Bhat AN. A comparison of the effects of rhythm and robotic interventions on repetitive behaviors and affective states of children with Autism Spectrum Disorder (ASD). RESEARCH IN AUTISM SPECTRUM DISORDERS 2015; 18:51-63. [PMID: 26251668 PMCID: PMC4523306 DOI: 10.1016/j.rasd.2015.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
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.
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Affiliation(s)
- Sudha M Srinivasan
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA ; Biomechanics & Movement Science Program, University of Delaware, Newark, DE 19713, USA
| | - Isabel K Park
- Department of Kinesiology, Physical Therapy Program, University of Connecticut, Storrs, CT 06269, USA
| | - Linda B Neelly
- Department of Music Education, School of Fine Arts, University of Connecticut, Storrs, CT 06269, USA
| | - Anjana N Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA ; Biomechanics & Movement Science Program, University of Delaware, Newark, DE 19713, USA ; Department of Kinesiology, Physical Therapy Program, University of Connecticut, Storrs, CT 06269, USA ; Behavioral Neuroscience Program, University of Delaware, Newark, DE 19713, USA ; Center for Health, Intervention, and Prevention, Department of Psychology, University of Connecticut, Storrs, CT 06269, USA
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Ghasemtabar SN, Hosseini M, Fayyaz I, Arab S, Naghashian H, Poudineh Z. Music therapy: An effective approach in improving social skills of children with autism. Adv Biomed Res 2015; 4:157. [PMID: 26380242 PMCID: PMC4550953 DOI: 10.4103/2277-9175.161584] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/17/2015] [Indexed: 11/06/2022] Open
Abstract
Background: The existing methodological weakness in conducted researches concerning music therapy (MT) for children with autism led to ambiguity and confusion in this scope of studies. The aim of the present research is to identify the effectiveness of MT method in improving social skills of children with autism and its stability, as well. Materials and Methods: In the form of a clinical trial study with design of pretest/posttest/follow-up with control group, among the children with autism in community of Tehran city, on the basis of childhood autism rating scale, 27 children with mild to moderate autism were chosen and were divided into two groups of experiment (n = 13), and control (n = 14). Social skills’ level of both groups was measured and recorded with the help of social skills rating system scale. The children of the experiment group participated in MT programs of Orff–Schulwerk for 45 days in 12 sessions (two sessions of 1-h/week), whereas the control group received no intervention. The data were analyzed with Statistic Package For Social Science (SPSS) software t-test and analysis of covariance was used to compare groups. Results: In posttest, the results of covariance analysis showed a significant increase in social skills’ scores of the experiment group (P < 0.001). Also, results of the paired-sample t-test showed that the effectiveness of MT has been persistent up to the follow-up phase. Conclusions: The study showed that MT is an effective method with deep and consistent effects on improving social skills of children with autism.
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Affiliation(s)
| | | | - Irandokht Fayyaz
- Department of Education, Allameh Tabatabai University, Tehran, Iran
| | - Saeid Arab
- Department of General Psychology, Kharazmi University, Tehran, Iran
| | | | - Zahra Poudineh
- Department of Children Psychology, Islamic Azad University of Birjand, Birjand, Iran
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Geretsegger M, Holck U, Carpente JA, Elefant C, Kim J, Gold C. Common Characteristics of Improvisational Approaches in Music Therapy for Children with Autism Spectrum Disorder: Developing Treatment Guidelines. J Music Ther 2015; 52:258-81. [DOI: 10.1093/jmt/thv005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
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.
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Affiliation(s)
- Monika Geretsegger
- Uni Health, Uni ResearchGAMUT ‐ The Grieg Academy Music Therapy Research CentreLars Hilles gate 3BergenNorway5015
| | - Cochavit Elefant
- University of HaifaDepartment of Creative Arts TherapiesHecht's Art Building, ‐1 Floor, Room 26HaifaIsrael3498838
| | - Karin A Mössler
- Uni Health, Uni ResearchGAMUT ‐ The Grieg Academy Music Therapy Research CentreLars Hilles gate 3BergenNorway5015
| | - Christian Gold
- Uni Health, Uni ResearchGAMUT ‐ The Grieg Academy Music Therapy Research CentreLars Hilles gate 3BergenNorway5015
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Meta-analysis of social skills interventions of single-case research for individuals with autism spectrum disorders: results from three-level HLM. J Autism Dev Disord 2013; 43:1701-16. [PMID: 23212808 DOI: 10.1007/s10803-012-1726-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This meta-analysis used hierarchical linear modeling to examine 115 single-case studies with 343 participants that examined the effectiveness of social skills interventions for individuals with autism spectrum disorder (ASD). The average effect size of the included studies was 1.40 (SD = 0.43, 95% CL = 1.32-1.48, N = 115). In the further, several common predictors including intervention length, age and gender of the participants, and study quality indicators (provision of sufficient, in-depth, and replicable information of participants, settings/materials, independent variables, and dependent variables) were not found to mediate the intervention effectiveness. Only research design that the study employed was found to impact the intervention effectiveness; the studies using multiple baseline or reversal design had larger effect sizes than studies using other designs. Implications of the results and limitations of this study are discussed.
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Mizuno E, Sakuma H. Wadaiko performance enhances synchronized motion of mentally disabled persons. Percept Mot Skills 2013; 116:187-96. [PMID: 23829145 DOI: 10.2466/15.22.24.pms.116.1.187-196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
People with mental disabilities tend to lack communication skills and have difficulty with interpersonal relationships. Interpersonal communication skills were examined in two people with Down Syndrome with regard to playing wadaiko (Japanese drum). Motion analysis compared single play and two-person play in which one participant was more skillful than the other. The effect of wadaiko play was quantified using two different methodologies: motion delay and hit-timing analysis and visual analog-scale (VAS) ratings before and after play. The motion analysis indicated that the study participants became mutually synchronized in playing wadaiko, and that a participant played more accurately when he played with a senior member. VAS ratings indicated that participants felt more positive after practicing wadaiko than before and self-confidence improved. Synchronized gestures of wadaiko performance may be an effective therapy for people with limited communication skills.
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Srinivasan SM, Bhat AN. A review of "music and movement" therapies for children with autism: embodied interventions for multisystem development. Front Integr Neurosci 2013; 7:22. [PMID: 23576962 PMCID: PMC3620584 DOI: 10.3389/fnint.2013.00022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/21/2013] [Indexed: 12/27/2022] Open
Abstract
The rising incidence of Autism Spectrum Disorders (ASDs) has led to a surge in the number of children needing autism interventions. This paper is a call to clinicians to diversify autism interventions and to promote the use of embodied music-based approaches to facilitate multisystem development. Approximately 12% of all autism interventions and 45% of all alternative treatment strategies in schools involve music-based activities. Musical training impacts various forms of development including communication, social-emotional, and motor development in children with ASDs and other developmental disorders as well as typically developing children. In this review, we will highlight the multisystem impairments of ASDs, explain why music and movement therapies are a powerful clinical tool, as well as describe mechanisms and offer evidence in support of music therapies for children with ASDs. We will support our claims by reviewing results from brain imaging studies reporting on music therapy effects in children with autism. We will also discuss the critical elements and the different types of music therapy approaches commonly used in pediatric neurological populations including autism. We provide strong arguments for the use of music and movement interventions as a multisystem treatment tool for children with ASDs. Finally, we also make recommendations for assessment and treatment of children with ASDs, and provide directions for future research.
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Affiliation(s)
- Sudha M. Srinivasan
- Department of Kinesiology, Neag School of Education, University of ConnecticutStorrs, CT, USA
- Center for Health, Intervention, and Prevention, University of ConnecticutStorrs, CT, USA
| | - Anjana N. Bhat
- Department of Kinesiology, Neag School of Education, University of ConnecticutStorrs, CT, USA
- Center for Health, Intervention, and Prevention, University of ConnecticutStorrs, CT, USA
- Center for the Ecological Study of Perception and Action, University of ConnecticutStorrs, CT, USA
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Characteristics of single-case designs used to assess intervention effects in 2008. Behav Res Methods 2011; 43:971-80. [DOI: 10.3758/s13428-011-0111-y] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gattino GS, Riesgo RDS, Longo D, Leite JCL, Faccini LS. Effects of relational music therapy on communication of children with autism: a randomized controlled study. NORDIC JOURNAL OF MUSIC THERAPY 2011. [DOI: 10.1080/08098131.2011.566933] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Music Interventions for Children with Autism: Narrative Review of the Literature. J Autism Dev Disord 2011; 41:1507-14. [DOI: 10.1007/s10803-010-1172-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW The review explores current trends in the behavioral intervention literature for children with an autism spectrum disorder (ASD) during 2008 and 2009. Noteworthy findings and intervention strategies are highlighted. Additionally, the quality of all reviewed studies is systematically evaluated. RECENT FINDINGS During 2008 and 2009, there was nearly a quarter increase in the number of behavioral intervention studies, as well as more randomized controlled trials and approaches other than applied behavior analysis. Many of the studies investigated commonly used ASD intervention practices or novel treatments. A few were conducted with underserved populations, such as toddlers and adults with ASD. Social impairment was the focus of the largest number of intervention studies. A small percentage of studies were rated as high-quality. SUMMARY Overall, the reviewed studies suggest that ASD-specific deficits can be improved through behavioral intervention. However, whereas progress continues to be made in our understanding of effective treatments for children with ASD, confidence in these findings would be improved with higher-quality studies.
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Wan CY, Demaine K, Zipse L, Norton A, Schlaug G. From music making to speaking: engaging the mirror neuron system in autism. Brain Res Bull 2010; 82:161-8. [PMID: 20433906 PMCID: PMC2996136 DOI: 10.1016/j.brainresbull.2010.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 04/01/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
Individuals with autism show impairments in emotional tuning, social interactions and communication. These are functions that have been attributed to the putative human mirror neuron system (MNS), which contains neurons that respond to the actions of self and others. It has been proposed that a dysfunction of that system underlies some of the characteristics of autism. Here, we review behavioral and imaging studies that implicate the MNS (or a brain network with similar functions) in sensory-motor integration and speech representation, and review data supporting the hypothesis that MNS activity could be abnormal in autism. In addition, we propose that an intervention designed to engage brain regions that overlap with the MNS may have significant clinical potential. We argue that this engagement could be achieved through forms of music making. Music making with others (e.g., playing instruments or singing) is a multi-modal activity that has been shown to engage brain regions that largely overlap with the human MNS. Furthermore, many children with autism thoroughly enjoy participating in musical activities. Such activities may enhance their ability to focus and interact with others, thereby fostering the development of communication and social skills. Thus, interventions incorporating methods of music making may offer a promising approach for facilitating expressive language in otherwise nonverbal children with autism.
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Affiliation(s)
- Catherine Y. Wan
- Department of Neurology, Music and Neuroimaging Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Krystal Demaine
- Department of Neurology, Music and Neuroimaging Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Lauryn Zipse
- Department of Neurology, Music and Neuroimaging Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Charlestown Navy Yard, Boston, MA 02129, USA
| | - Andrea Norton
- Department of Neurology, Music and Neuroimaging Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Gottfried Schlaug
- Department of Neurology, Music and Neuroimaging Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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