Bieleninik, L., Geretsegger, M., Mössler, K., Assmus, J., Thompson, G., Gattino, G., Elefant, C., Gottfried, T., Igliozzi, R., Muratori, F., Suvini, F., Kim, J., Crawford, M. J., Odell-Miller, H., Oldfield, A., Casey, Ó, Finnemann, J., Carpente, J., Grossi, E., & Gold, C. (2017). Effects of improvisational music therapy vs enhanced standard care on symptom severity among children with autism spectrum disorder. Journal of the American Medical Association, 318(6), 525-535. https://doi.org/10.1001/jama.2017.9478

Reviewed by:
Julia L. Ferguson, MS, BCBA and Mary Jane Weiss, PhD, BCBA-D
Applied Behavior Analysis Doctoral Program, Endicott College

Why research this topic?

Research Synopses topic: Escape Extinction Procedure Using Protective Equipment on Self-Injurious BehaviorChildren diagnosed with autism spectrum disorder (ASD) have deficits in social communication and engage in restricted and repetitive behaviors (American Psychiatric Association, 2013). One intervention that has been developed to help target social communication deficits is improvisational music therapy. Improvisational music therapy consists of a music therapist and the child spontaneously creating music together, singing, playing, and incorporating movement and dance. This therapy is said to help improve social communication skills, such as joint attention and social interaction, and parent-child interactions. The purpose of this study was to assess the effects of improvisational music therapy on social communication skills for children diagnosed with ASD.

What did the researchers do?

To assess the effects of improvisational music therapy, the researchers recruited 364 participants from nine different countries (i.e., Australia, Austria, Brazil, Israel, Korea, Norway, United Kingdom, and the United States). All participants had a diagnosis of ASD and were between the ages of four to six years. Prior to intervention, researchers conducted the Autism Diagnostic Observation Schedule (ADOS), the Autism Diagnostic Interview-Revised (ADI-R), and administered an IQ test for all participants. Parents or caregivers also completed the Social Responsiveness Scale (SRS) and a quality-of-life scale prior to beginning intervention. Participants were then randomly assigned to a treatment condition. One condition consisted of low-intensity music therapy in addition to standard care procedures (see elaboration below). The second condition consisted of high-intensity music therapy with standard care procedures. The third condition was standard care alone.

The low-intensity music therapy group went to music therapy once a week over a period of five months. The high-intensity music therapy went to music therapy sessions three times a week over five months. Music therapy consisted of a music therapist engaging in joint musical activities with the participants, mirroring/imitating the child, and singing to increase positive affect and joint attention. All conditions included standard care procedures which consisted of professionals offering to discuss parent concerns, provide information on ASD, and describe the protocols of the music therapy intervention. Additionally, standard care consisted of three 1-hour parent counseling sessions across 5 months. During intervention, the researchers assessed the participant’s ADOS social affect domain scores and SRS scores through the use of assessors blind to the condition assignments at 2, 5, and 12 months after treatment.

What did the researchers find?

The researchers found that there was no difference between the groups for improvements in social communication based on the ADOS social affect domain scores. Additionally, no significant differences in improvement were found between the intensity of music therapy groups (i.e., high and low intensity). The researchers did find small, but significant, effects on several of the SRS subscales (i.e., social motivation, social awareness) with music therapy being associated with improvements on this measure compared to the standard care group.

What are the strengths and limitations of the study?

The strengths of this research study include the recruitment of participants worldwide and conducting the study across multiple sites and countries. The researchers also used multiple assessments to measure social-communication improvements across multiple responders or assessors (i.e., parents, researchers). Additionally, the researchers who conducted the ADOS testing were blind to which participants were in each condition. This helped protect the results from bias. Limitations of this study include that music therapy procedures and standard care procedures were not tightly controlled, so inconsistencies in the therapists’ approaches could have occurred across sites. Parents may also have been positively biased toward seeing results which in turn may have affected their responding on the SRS at follow-up. Additionally, the researchers suggest that the intervention and follow-up measures could have occurred over longer durations considering therapy for children with ASD typically occurs over years instead of months.

What do the results mean?

Improvisational music therapy was not found to be an effective intervention for children diagnosed with ASD other than producing small positive increases on parents’ perception of their child’s social-communication behaviors. Although improvisational music therapy was found to be an enjoyable and acceptable form of therapy for participants and parents (analyzed via a qualitative study in connection with this study; Blauth, 2017), it was not found to be effective as a treatment for ASD. It is possible that the intervention was not delivered intensely enough to see an effect. In addition, the duration may have been inadequate. If researchers pursue this area, it would be important to address these limitations. In the interim, improvisational music therapy does not appear to provide clinical benefit, but music activities may be used as a leisure opportunity and source of enjoyment for people with ASD.

Citations within this synopsis:

American Psychiatric Association. (2013). Diagnositic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Blauth, L. K. (2017). Improving mental health in families with autistic children: Benefits of using video feedback in parent counselling sessions offered alongside music therapy. Health Psychology Reports, 5(2), 138-150. https://doi.org/10.5114/hpr.2017.63558

Citation for this article:

Ferguson, J. L., & Weiss, M. J. (2022). Research synopsis: Effects of improvisational music therapy vs enhanced standard care on symptom severity among children with autism spectrum disorder. Science in Autism Treatment, 19(2).

Related ASAT Research Synopses: ​

Related Media Watch Letters: ​

Print Friendly, PDF & Email