But he acknowledged that starting the intervention at a very early age may have some benefits, as could continuing the therapy for longer than 5 months. The new findings differ from those of some previous studies, including a Cochrane Collaboration meta-analysis. But previous trials were shorter and were limited to one center and one or just a few therapists.
The burden associated with attending music therapy sessions needs to be considered, however, said Dr Gold. In this study, those in the music therapy group tended to receive fewer therapies of other kinds, and some parents found it difficult to take their child to all planned sessions. The researchers have carried out post hoc analyses that uncovered some "interesting" findings, said Dr Gold. People should not "just assume" that music therapy, or any therapy, is effective in children with autism, said Dr Gold.
There should be rigorous evidence for it from research, as is common in other medical conditions. Music therapy will need to be developed further in order to better target those most likely to benefit from it, said Dr Gold.
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- No Reduction in Autism Symptoms With Music Therapy.
- Authors and Disclosures.
Arshya Vahabzadeh, MD, innovation officer, Massachusetts General Hospital, and chief medical officer, Brain Power, a neurotechnology company that has developed artificially intelligent smart glasses for people with autism, commented on the findings for Medscape Medical News. Dr Vahabzadeh praised the study for its large size and for being "robust" and "methodologically sound.
These elements, he said, make it "a little more pragmatic and realistic" than previous research in reflecting the community. The disadvantage, however, is that having such broad inclusion criteria creates a very heterogeneous sample, said Dr Vahabzadeh. Outcomes other than the primary one used in the study might be more meaningful to children with autism and their parents by, for example, reducing family stress, enhancing adaptive skills, improving sleep, or creating a more soothing environment, said Dr Vahabzadeh.
And, he stressed, the results "very clearly don't mean that kids with autism don't like music. Many do.
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They said it addressed a number of limitations of the previous Cochrane review; in addition to enrolling a large number of participants and using a narrow age range for inclusion, it tested a single form of music therapy and monitored intervention fidelity. However, they point out that few children were ineligible for the study and that children of any intelligence level were included, as were those with comorbid conditions. As with Dr Vahabzadeh, they noted that because of the approach used in the study, results may be averaged over a heterogeneous population of possible responders and nonresponders, "thereby reducing investigators' ability to show differences in aggregate.
The editorial writers also commented, as did the study authors, that participants who received music therapy attended fewer non—music therapy interventions than did the control group 36 vs 45 sessions. Music therapy, they said, "is designed to supplement — not substitute for — standard ASD treatment. Given the strong theoretical basis for music therapy and empirical support for it from multiple small studies, an explanatory approach — rather than a pragmatic approach, such as the one used in the study — might be an equally valid way to ascertain the potential effects of music therapy under more tightly controlled circumstances, write Dr Broder-Fingert and colleagues.
They conclude that it "seems premature" to definitively conclude that the new findings mark the end of improvisational music therapy as a potential intervention for children with ASD. Dr Gold and the editorialists have disclosed no relevant financial relationships. Published online August 8, Abstract , Editorial. You've successfully added to your alerts. You will receive email when new content is published.
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Music Therapy May Not Help Treat Autism
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Log out Cancel. Authors and Disclosures Journalist Pauline Anderson.
Commenting is limited to medical professionals. To comment please Log-in. Comments on Medscape are moderated and should be professional in tone and on topic. This process involves the application of intentional and developmentally appropriate music experiences. Furthermore, music therapy interventions can be combined with evidence-based strategies, including reinforcement, prompting, and picture schedules.
There is a long history of the use of music and music therapy services to help individuals with ASD achieve nonmusical goals, including social skills. Clinicians and researchers have investigated the impact of music therapy from behavioral, 15 relationship-centered, 16 applied behavior analysis-based, 17 family-centered, 18 social communication—emotional regulation—transactional support SCERTS model-based, 19 , 20 improvisational, 21 and neurological 22 approaches to facilitate social skills and communication.
Therefore, there are many different approaches and interventions that can be used to target social skills in music therapy. One commonality between these approaches is the use of musical stimuli and musical engagement to provide a foundation for enhanced socialization in children with ASD, leading to improved nonmusic social skills. Music therapy is a unique treatment approach that uses music experiences that can engage children in meaningful interactions with others.
Many children with ASD respond positively to music experiences, making music a safe and structured stimulus for social engagement and the practice of social skills. There are several reasons that musical stimuli may help with developing social skills. Music has been demonstrated to activate neural networks involved in similar musical and nonmusical tasks eg, speech and singing both activate the left inferior frontal gyrus 23 , 24 and further has the ability to optimize target behaviors through synchronized neural firings. In addition to enhanced processing of music in persons with ASD, the mechanisms of musical stimuli may provide a foundation for learning social skills.
The rhythmic and structural components of musical stimuli provide an external cue or anchor to further help children with ASD to organize, predict, and respond. A lack of neural organization in children with ASD may prevent children with ASD from appropriately responding to their environment due to difficulties with sensory overload, planning, initiation, and completing motor sequences. Rhythm and music may provide a unique accommodation for these deficits, as musical stimulus is highly predictable and has been widely shown to help with planning and execution of motor patterns.
Therefore, the characteristics of the musical experience serve as a structure for completing social interactions. Although musical stimuli provide a clear time-based structure, music exploration is also inherently flexible, as musical improvisations can use different tonalities, harmonies, melodies, phrase lengths, motives, and structure.
For example, the use of strict structure can be provided to help with anticipation of a back-and-forth communication, while improvisation within a certain modality ie, major or minor key and the use of different melodic themes on a pitched instrument allow for creativity. Within this experience, rhythm may be held constant in order to promote the anticipation and timing of musical communication, supporting the overall social interaction. This musical experience, wherein the client and therapist may be passing musical phrases back and forth, provides a means for practicing social interaction within a structure that provides accommodations to promote success.
For example, this experience could be completed with school-aged children with ASD who have little to no verbal language, providing a nonverbal means for practicing social engagement, turn taking, joint attention, and other fundamental social skills. Music therapy interventions are indicated to have positive effects on social skills, including increased engagement behavior, 36 increased emotional engagement, 37 and improved social interaction. Although music therapy interventions can promote social skills in individuals with ASD, there is continued need for larger-scale research, as many studies focused on music therapy for social skills comprise a single-subject design or are case studies.
Furthermore, there are unique challenges to outcome measurement in music therapy.source url
A Look at the Clinical Uses of Music Therapy
Most music therapy professionals use standardized scales or published observational scales as a part of pretest and posttest measurement of outcomes. These scales provide information about generalization of skills; however, they may not accurately reflect changes that are occurring within music experiences. Researchers have also used observation of behaviors within the sessions to determine whether children with ASD demonstrate more social interactions when engaged in musical experiences.
Social behavior has also been investigated in terms of musical engagement, with observational behavior recording during the music therapy treatment sessions or on completion of a music therapy assessment scale. In the following section, the unique aspects of outcome measurement for social skills in children with ASD are discussed. Clinical assessment in music therapy serves two functions, namely, to track the functioning level of the client during the course of treatment and to determine the optimal selection of treatment protocols.
One difficulty in assessing social skills in children with ASD is that many of the nonmusical assessment tools that are readily available consist of subjective scales of behavior such as the CARS. Other scales may be training or time prohibitive such as Autism Diagnostic Observation Schedule.
Autism & Music Therapy: A Case Study - Rehabilitative Rhythms Music Therapy
Therefore, in order to determine whether gains are being made as a result of music therapy treatment, the music therapy professional may use a combination of assessment tools, including parent-report scales such as the Autism Treatment Evaluation Checklist , clinician-based observation scales such as the Functional Emotional Assessment Scale , clinical session data documentation, interview, or observation of the client across different settings.
As many music therapists are members of a larger interdisciplinary treatment team, 48 observations from other professionals may inform the music therapist as to the generalization of skills in other settings. Music therapists also use musical materials in order to assess nonmusical functioning, including social skills. The assessment has sections for social integration, communication, stereotyped and repetitive behaviors, sensory—motor issues, and affective dysregulation including temper tantrums and aggression.