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Music therapy for autism shows minimal social benefit

by  /  30 August 2017
Girl playing the piano while a teacher guides her along the music.
Joint effort: A strong connection with a music therapist may help children with autism improve their social skills.

Imgorthand / iStock

Music therapy does not alleviate social difficulties in children with autism, suggests a large international study1.

Engaging with music is thought to help children become more flexible, responsive and attentive, leading to better social and communication skills. But participants with autism who received improvisational music therapy scored no better on a standard diagnostic test for the condition than did children with autism who did not get the therapy. The results were published 8 August in JAMA.

Still, researchers should not give up on investigating music’s potential to ease autism features, says lead investigator Christian Gold, professor of music therapy at the University of Bergen in Norway. The study may have missed improvements in a subset of the participants, he says.

“The message therefore is that therapy needs to be improved, either by making sure that therapists work more consistently or by better targeting the therapy, or perhaps by increasing the duration of therapy,” Gold says.

Other researchers also say they hope the findings lead to evidence-based music therapy.

“This is an important first step for the field,” says Alan Turry, managing director of the Nordoff-Robbins Center for Music Therapy at New York University, who was not involved in the new study. “Though the findings are disappointing,” he says, one-size-fits-all treatments seldom yield positive research results. “We now have an important opportunity to build on this study and find what benefits occur for which groups of patients under what conditions.”

Small drop:

The researchers followed 364 children with autism, ages 4 to 7 years old, in nine countries over five months. All participants received the standard care for autism available in their region, such as behavioral interventions, communication training and speech therapy. A subset of 182 of the children also received music therapy.

These children participated in 30-minute one-on-one sessions either three times a week or once a week. In each session, experienced music therapists directed joint activities, including improvised singing and playing instruments.

The children who received the music therapy, regardless of the frequency, and the controls both showed a small decrease in scores on a subscale of the Autism Diagnostic Observation Schedule that measures difficulties in social skills. The average score decreased from 14.08 to 13.23 among children who received the music therapy versus 13.49 to 12.58 among those who received only standard care. The difference between the groups is not statistically significant.

The study design may have played a role in the negative result, says Sarabeth Broder-Fingert, assistant professor of pediatrics at Boston University, who was not involved in the work.

To mirror the diversity of children with autism that therapists encounter, the researchers chose relatively broad criteria for enrolling participants. For instance, they made no restrictions on children’s cognitive abilities, so the participants’ intelligence quotients vary widely. The resulting noise in the data may have masked statistically significant effects, Broder-Fingert says.

Positive note:

In 2014, Gold and his colleagues reviewed 10 smaller studies of music therapy for children with autism. Their analysis found some benefits of the therapy, including improved social and verbal skills.

Clinical observations also suggest there are several ways to make music therapy more effective in this population, Gold says.

For example, children with autism who actively engage in musical activities and connect well with a music therapist show marked improvements in their social abilities, according to early findings from a separate study by Gold’s team.

Conducting sessions for longer than five months, possibly with parents also participating, may render the therapy more effective, Gold says.

Improvisational music therapy brought other benefits to the children in the new study who received it three times a week, he says. In post-session interviews, parents reported a significant increase in their and their children’s quality of life. Families may also be more interested in outcomes other than test scores, such as pleasure in the activity or improvements in functioning at school.

Researchers don’t know enough about how music affects the brain, Gold says. “How does it actually work?” he asks. Answering that question might help scientists design studies that help subsets of children with autism.


References:
  1. Bieleninik L. et al. JAMA 318, 525-535 (2017) PubMed

7 responses to “Music therapy for autism shows minimal social benefit”

  1. Sharena says:

    The children participated in one-on-one sessions in this study, but what about playing music in a band? I think having common interests and a common goal with other people makes it easier to connect socially. This common goal needs to be mutual, and music can be a way to make that happen.

  2. So let’s denounce Music Therapy for autism due to one random study not at all in tune (sorry for the pun) with anything about autism. The picture illustrating the article was confusing to me since how does a child working with an adult teacher on music principles on the piano keyboard do anything to promote “social interaction and communication” with anyone but the music therapist or within the environmental setup of the music lesson? There is something called “generalization” and it requires it be built into the intervention and measured as the learned “responsiveness and attention” is paired with real world applications. Is the teacher trained in behavioral methodology, ABA or have they special training in the unique disorder called autism? Oh, I see now.
    After consulting the real research abstract it seems that they chose to randomly compare the outcomes of closed Improvisational (?) Music Therapy sessions to the closed Enhanced standard care group which consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. Both groups closed out the parents from either groups or anyone else (except that the standard of care may have included other caregivers who could have been used to generalize the music outcomes). Why do this when the evidence-based outcomes of studies already published show parents to be the best reinforcers of learning, behavioral and social outcomes for children with autism. And anyway, who tests two disparate things? Shouldn’t they both have had “Enhanced standard care’ but only one group also had music as a part of the care? Anyone who has worked with kids with autism knows that group music-making that uses the juicy fruit of music with goals requiring eye contact with peers/others, specific types of music that is reinforcing or preferential to the child and requires whole person strategies like body movement (reaching for instrument access, CD player buttons, sign language for pauses in music, etc. requiring input from a social partner, observing and copying the modeling of others) and maybe even some video-modeling or self video-modeling is more likely to procure learning but the social context USING MUSIC needs to be broadened prior to making false conclusions. Music therapy alone is a joyous thing, but I don’t know why some of the therapists have walked right by the caregiving partner and into a room and shut the door? Music Therapy can inspire the first signs of joint attention and requesting/social commenting, but for autism it will have to generalized with the parents, siblings, classmates, teachers, etc. or as often happened it will be lost.

  3. Flewellyn says:

    “Ease autism features”?

    YOUR GOALS ARE BAD, AND YOU SHOULD FEEL BAD!

  4. Darcy DeLoach says:

    The University of Louisville’s Music Therapy Faculty responds to the American Music Therapy Association’s call for dialogue on the TIME-A study and the related body of research. This video response is an effort to advance knowledge and support improvements for safe, effective, and evidence-informed music therapy interventions for persons with Autism Spectrum Disorder.
    https://youtu.be/2lkdMWnISq8

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