Content uploaded by Cynthia Di Francesco
Author content
All content in this area was uploaded by Cynthia Di Francesco on Jan 14, 2022
Content may be subject to copyright.
Joint engagement and movement: Active ingredients of a music-based intervention with school-age children with autism
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.
... We adapted Adamson et al. (2004)'s joint engagement coding scheme, previously shown to be sensitive to intervention effects (Kasari et al., 2010) in a school-age autistic population, to our MI and nonMI intervention activities. Our coding scheme (Latif et al., 2021) consists of four categories of joint engagement: coordinated joint, supported joint, object, and other. Here we focus on the highest level of joint engagement, coordinated joint engagement, exclusively and examine potential interactions with verbal IQ. ...
... Reliability for the coordinated joint code (ICC = 0.70, 95% CI = 0.57-0.79) was moderate, following guidelines by Koo and Li (2016), though other codes reached a good level of reliability (Latif et al., 2021). The change score in percent time spent in a coordinated joint engagement state between the last and first intervention session (i.e., last intervention session -first intervention session/ first intervention session + last intervention session * 100) was used as the outcome variable for this analysis. ...
... Joint engagement, recently highlighted as an active ingredient of music-mediated interventions (Latif et al., 2021), can be defined as engagement involving two individuals and ...
Purpose:
Autistic children with limited spoken language ability (LSLA) often do not respond to traditional interventions, reducing their social inclusion. It is essential to identify effective interventions, and sensitive measures to track their intervention response.
Methods:
Using data from an RCT comparing music-mediated and play-based interventions, we investigated the impact of spoken language ability on outcomes, and measured response to intervention through natural language sample measures.
Results:
Children with lower verbal IQ, relative to higher verbal IQ, made some greater gains over the course of music-mediated intervention. Natural language samples were helpful in characterizing communication and tracking change.
Conclusion:
Music-mediated interventions hold promise as effective interventions for autistic children with LSLA. Natural language samples are robust in characterizing this subgroup.
... Twenty-five different pieces and genres were the basis for this research study. Latif et al. (2021) research stated the collaborative effort of 'two active ingredients,' including the ASD child and therapist. The term multi-based interventions are more effective than other treatments of similar intensity. ...
This study explored how best to implement Music Therapy (MT) in any hospital setting
... The promising results of the music interventions mentioned above suggest that it would be fruitful to examine the specificity of JMM for prosocial outcomes, as well as discernment of critical musical components that drive these effects. Studies targeting specific components have already pioneered these future directions (Latif et al., 2021;Spiro and Himberg, 2016;Yoo and Kim, 2018). Still, more research is needed as well as greater multidisciplinary collaboration. ...
... Increased auditory-motor/frontotemporal resting-state functional connectivity after training in the music therapy group was correlated with the increased communication scores. A video-coding analysis of behavior during these interventions showed that the children on the autism spectrum who participated in the music intervention had greater improvement in joint attention and movement than those who participated in the active control intervention (Latif et al., 2021). ...
Inhibition control is an essential executive function during children's development, underpinning self-regulation and the acquisition of social and language abilities. This executive function is intensely engaged in music training while learning an instrument, a complex multisensory task requiring monitoring motor performance and auditory stream prioritization. This novel metaanalysis examined music-based training on inhibition control in children. Records from 1980 to 2023 yielded 22 longitudinal studies with controls (N = 1734), including 8 RCTs and 14 others. A random-effects meta-analysis showed that music training improved inhibition control (medium ES) in the RCTs and the superset of twenty-two longitudinal studies (small-to-medium ES). Music training plays a privileged role compared to other activities (sports, visual arts, drama) in improving children's executive functioning, with a particular effect on inhibition control. We recommend music training for complementing education and as a clinical tool focusing on inhibition control remediation (e.g., in autism and ADHD).
Across different epochs and societies, humans occasionally gather to jointly make music. This universal form of collective behavior is as fascinating as it is fragmentedly understood. As the interest in joint music making (JMM) rapidly grows, we review the state-of-the-art of this emerging science, blending behavioral, neural, and computational contributions. We present a conceptual framework synthesizing research on JMM within four components. The framework is centered upon interpersonal coordination, a crucial requirement for JMM. The other components imply the influence of individuals’ (past) experience, (current) social factors, and (future) goals on real-time coordination. Our aim is to promote the development of JMM research by organizing existing work, inspiring new questions, and fostering accessibility for researchers belonging to other research communities.
The first years of life are critical for language development. Numerous studies indicate that actively participating in music creates a neural processing advantage in brain regions that support language development. Nevertheless, shared social characteristics between music and language may also play a role in explaining the benefits of music engagement during infancy for language development. The causal effects of a social learning pathway explaining the relation between music and language development in infants have not been fully elucidated. In this article, we posit that music enrichment programs indirectly benefit language development through enhanced parental responsiveness, an aspect of high‐quality parent–infant interactions. We summarize research on parent–child music enrichment classes and early language development. We also provide a narrative review and conceptual model of relevant research to support how parental responsiveness may partly explain the association between participating in music enrichment programs during infancy and benefits to early language development.
Neurodevelopmental disorders like ADHD can affect rhythm perception and production, impacting the performance in attention and sensorimotor tasks. Improving rhythmic abilities through targeted training might compensate for these cognitive functions. We introduce a novel protocol for training rhythmic skills via a tablet-based serious game called Rhythm Workers (RW). This proof-of-concept study tested the feasibility of using RW in children with ADHD. We administered an at-home longitudinal protocol across Canada. A total of 27 children (7-13 years) were randomly assigned to either a finger-tapping rhythmic game (RW) or a control game with comparable auditory-motor demands but without beat-synchronization (active control condition). Participants played the game for 300 minutes over two weeks. We collected data (self-reported and logged onto the device) on game compliance and acceptance. Further, we measured rhythmic abilities using the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA). The current findings show that both games were equally played in duration, rated similarly for overall enjoyment, and relied on similar motor activity (finger taps). The children who played RW showed improved general rhythmic abilities compared to controls; these improvements were also positively related to the playing duration. We also present preliminary evidence that executive functioning improved in those who played RW but not controls. These findings indicate that both games are well-matched. RW demonstrates efficacy in enhancing sensorimotor skills in children with ADHD, potentially benefiting executive functioning. A future RCT with extended training and sample size could further validate these skill transfer effects.
Além da psicoterapia, terapia ocupacional e fonoaudiologia, outras práticas terapêuticas têm demonstrado bons resultados na melhora de problemas relacionados à comunicação e interação social no autismo, tais como a musicoterapia. Objetiva-se verificar o impacto no desenvolvimento de crianças com transtorno do espectro autista, a partir da musicoterapia como terapia complementar. Trata-se de uma revisão integrativa, realizada nas bases de dados PubMed e SciELO, em novembro de 2023. utilizando-se dos descritores “Autism”; “Music therapy”, juntamente com o operador booleano ‘AND’. Um total de 05 artigos compuseram a presente revisão, entre estudos controlados e ensaios clínicos, os quais foram desenvolvidos na Noruega, França, Estados Unidos, Canadá e China, publicados em periódicos entre 2020 e 2022. A musicoterapia proporciona melhoria da interação social, dos comportamentos restritos e repetitivos, letargia, estereotipia, coordenação motora, envolvimento com o terapeuta e a atividade, movimento corporal, linguagem e autocuidado. Além disso, está relacionada à melhoria da interação, cooperação e intimidade entre pais e filhos.
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.
This study presents techniques for quantitatively analyzing coordination and kinematics in multimodal speech using video, audio and electromagnetic articulography (EMA) data. Multimodal speech research has flourished due to recent improvements in technology, yet gesture detection/annotation strategies vary widely, leading to difficulty in generalizing across studies and in advancing this field of research. We describe how FlowAnalyzer software can be used to extract kinematic signals from basic video recordings; and we apply a technique, derived from speech kinematic research, to detect bodily gestures in these kinematic signals. We investigate whether kinematic characteristics of multimodal speech differ dependent on communicative context, and we find that these contexts
can
be distinguished quantitatively, suggesting a way to improve and standardize existing gesture identification/annotation strategy. We also discuss a method, Correlation Map Analysis (CMA), for quantifying the relationship between speech and bodily gesture kinematics over time. We describe potential applications of CMA to multimodal speech research, such as describing characteristics of speech-gesture coordination in different communicative contexts. The use of the techniques presented here can improve and advance multimodal speech and gesture research by applying quantitative methods in the detection and description of multimodal speech.
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 neurobehavioral 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 6-12 year olds 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 versus 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 music compared to 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.
Music has played a prominent role in the clinical and research literature on Autism Spectrum Disorder (ASD) in regard to diagnosis, therapy, and behavioral observations of exceptional artistic abilities in this population. Music as therapy for ASD has traditionally focused on social interaction, communication skills, and social-emotional behaviors. However, recently, there has been an increased research focus on the role of motor and attention functions as part of the hallmark features of ASD, which may have significant implications for the role of music as an intervention for individuals with autism. The purpose of this paper is to provide a critical appraisal of new research developments for therapists and researchers to potentially reassess the role of music as intervention to support healthy neurodevelopment in individuals with ASD and expand the current clinical scope of practice in music therapy for autism. Our argument is based upon compelling research evidence indicating that motor and attention deficits are deeply implicated in the healthy neurodevelopment of socio-communication skills and may be key indicators of structural and functional brain dysfunction in ASD. In light of this evidence, we suggest that music-based developmental training for attention and motor control may receive a critical new functional role in the treatment of autism due to the significant effect of auditory-motor entrainment on motor and attention functions and brain connectivity.
Available at: http://journals.sagepub.com/doi/full/10.1177/2059204318769639
This study examined whether the therapeutic relationship in music therapy with children with Autism Spectrum Disorder predicts generalized changes in social skills. Participants (4–7 years, N = 48) were assessed at baseline, 5 and 12 months. The therapeutic relationship, as observed from session videos, and the generalized change in social skills, as judged by independent blinded assessors and parents, were evaluated using standardized tools (Assessment of the Quality of Relationship; ADOS; SRS). Linear mixed effect models showed significant interaction effects between the therapeutic relationship and several outcomes at 5 and 12 months. We found the music therapeutic relationship to be an important predictor of the development of social skills, as well as communication and language specifically.
Communicative Musicality’ explores the intrinsic musical nature of human interaction. The theory of communicative musicality was developed from groundbreaking studies showing how in mother/infant communication there exist noticeable patterns of timing, pulse, voice timbre, and gesture. Without intending to, the exchange between a mother and her infant follow many of the rules of musical performance, including rhythm and timing. This is the first book to be devoted to this topic. In a collection of cutting-edge chapters, encompassing brain science, human evolution, psychology, acoustics and music performance, it focuses on the rhythm and sympathy of musical expression in human communication from infancy. It demonstrates how speaking and moving in rhythmic musical ways is the essential foundation for all forms of communication, even the most refined and technically elaborated, just as it is for parenting, good teaching, creative work in the arts, and therapy to help handicapped or emotionally distressed persons. A landmark in the literature, ‘Communicative Musicality’ is a valuable text for all those in the fields of developmental, educational, and music psychology, as well as those in the field of music therapy.
Clinicians and researchers have provided strong evidence for the efficacy of Guided Imagery and Music (GIM) and similar therapies across a wide range of clinical conditions. What is still lacking is a theoretical framework that would allow for the identification of the ‘active ingredients’ in this process. This paper seeks to introduce a new systemic framework for investigating such therapies by examining the biological roots as well as the role of music in the regulation of individual and social life to maintain homeostasis via multimodality by means of arousal, imagery, attentional engagement, emotion, memory and analogous processes. Taking the work of Edelman, Damasio and other leaders of modern neuroscience as a point of departure, homeostasis and multimodality are presented as essential not only to the human life process in terms of our active mental life but also to the fullness of Edelman's "primary consciousness" and Damasio's "core self." The implications of these intricate cross-connections are considered as well as the unique propensity for music to spontaneously and multimodally engage these connections. Proposals are also made to evaluate these ideas and stimulate further research in both basic science and clinical practice. Keywords: multimodality, self, reentrant, signaling, homeostasis, consciousness, music therapySpanishImagineria Multimodal en musica: Ingredientes activos y los mecanismos que subyacen la participación musicalHarry Ballan , Anna AbrahamResumen: Clínicos e investigadores han provisto de sólida evidencia sobre la eficacia de la Imaginería Guiada y Música (GIM) y de terapias similares en un amplio rango de condiciones clínicas. Lo que aún falta es un marco teórico que permitiría identificar los “ingredientes activos” en este proceso. Este trabajo busca introducir un nuevo marco sistemático para la investigación de dichas terapias examinando los marcadores biológicos así como el rol de la música en la regulación del individuo y su vida social para mantener la homeostasis de manera multimodal por medio del alerta, la imaginería, el compromiso atencional, la emoción, la memoria y otros procesos análogos. Tomando el trabajo de Edelman, Damasio y otros líderes de la neurociencia moderna como punto de partida, la homeostasis y la multimodalidad son presentadas como esenciales no solo en los procesos de la vida humana en términos de nuestra vida activa mental sino también en la plenitud de la “conciencia primaria” de Edelman y del “core self” de Damasio. Las implicancias de estas intrincadas conexiones entrecruzadas son consideradas también como la propensión espontánea y multimodal de la música para enlazar estas conexiones. Se propone evaluar estas ideas y estimular nuevas investigaciones basadas tanto en la ciencia como en la práctica clínicaPalabras clave: msica, multimodal, imaginería, homeostasis, conciencia, musicoterapia GermanMultimodale Imagery in Music: Aktive Bestandteile und Mechanismen , die musikalischem Handeln zugrunde liegenHarry Ballan, Anna AbrahamKliniker und Forscher haben überzeugende Evidenz für die Wirkung von Guided Imagery and Music (GIM) und ähnlicher Therapien über ein weites Spektrum klinischer Zustände geliefert. Was noch fehlt, ist ein theoretischer Rahmen, der erlauben würde, die aktiven Bestandteile in diesem Prozess zu identifizieren. Dieser Beitrag versucht, einen neuen systemischen Rahmen für solche Therapien vorzustellen, indem die biologischen Wurzeln und die Rolle der Musik zur Regulation individuellen und sozialen Lebens untersucht werden, die über Multimodalitäten von Arousal, Imagery, attentionales Engagement, Emotionen, Erinnerung und analogen Prozessen Homöostase zu erhalten suchen. Wenn man die Arbeiten von Edelmann, Damasio und anderen führenden Personen der modernen Neurowissenschaften als Ausgangpunkt nimmt, werden Homöostase und Multimodalität als wesentlich nicht nur für den menschlichen Prozess unseres aktiven mentalen Lebens als auch als Fülle von Edelmans „primary consciousnes“ und Damasios „core self“ präsentiert. Die Verflechtungen dieser schwierigen Kreuz-Verbindungen werden sowohl als einzigartige Neigung für Musik bis zur spontanen und multimodalen Beteiligung dieser Verbindung angesehen. Es wurden bereits Vorschläge gemacht, diese Ideen zu evaluieren und weitere Forschung für Grundlagenwissenschaft und klinischer Praxis anzuregenKeywords: Musik, Multimodalität, Imagery, Homöostase, Bewusstsein, Musiktherapie. ItalianHarry Ballan, Anna Abraham Medici e ricercatori hanno forito una forte evidenza dell’efficacia della Guided Imagery and Music (GIM) e di terapie simili, applicate ad una vasta gamma di condizioni cliniche. Ciò che ancora manca è un quadro teorico che permetterebbe l’identificazione dei “principi attivi” in questo processo. Il presente documento si propone di introdurre un nuovo quadro sistematico per indagare tali terapia esaminando le radici biologiche, nonché il ruolo della musica nella regolazione della vita individuale e sociale mantenendo l’omeostasi per mezzo dell’eccitazione, l’immaginario, l’impegno dell’attenzione, emozione, memoria e altri processi analoghi. Prendendo il lavoro di Edelman, Damasio ed altri leader delle neuroscienze moderne come punto di partenza, l’omeostasi e la multimodalità sono essenzialmente presenti non solo per il processo della vita umana I termini di nostra vita mentale attiva, ma anche per la pienezza della “coscenza primadria di Edelman e il cuore di se stesso di Damasio. Le implicazioni di questi intricati collegamenti trasversali sono considerati come anche l’unica propensita per la musica di impegnare spontaneamente e multimodalmente quest connessioni. Le proposte per valutare queste idee e stimolare ultiriori ricerche sia nella scienza di base che nella pratica clinica sono fatte. Parole Chiave: musica, multimodalità, immaginario, omeostasi, musicoterapiaChinese音樂中的多元形式聯想：投入音樂帶來的活化元素與機制對於音樂引導意象(GIM)的廣泛應用及臨床上類似的治療法之效用，臨床工作者與研究者已提出許多有力的證據。然而，能用來定義在過程中的「活化元素」之理論架構則尚未完備。本文試以一種新的架構來研究這些治療，透過生理基礎以及音樂的多元形式與方法，如喚起、想像、集中注意力、將情緒和記憶類比的過程，調節社交生活並維持自我平衡。文中以Edelman、Damasio和其他現代神經科學領導者的觀點出發，以自我平衡及多元形式為基礎，不只是人類生活中的心智活動過程，也將Edelman所提的「首要意識」以及Damasio所謂的「核心自我」作為根基，將這些複雜而交錯連結的意義加以考慮，以音樂獨有的特性將這些多元的模式自發性的連結。作者建議未來要進一步評估這些想法，並激勵更多這方面的基礎科學研究與臨床實踐。Japanese音楽におけるマルチモーダル・イメージ： 音楽的エンゲージメントの基礎的な有効成分と仕組み Harry Ballan, Anna Abraham臨床家と研究者はGIM並びに広範囲での臨床条件における類似した療法の効能について強いエビデンスを提供してきた。理論構成上未だに不足しているのはこのプロセスにおける“有効成分”の証明を考慮に入れることである。本研究は、生物学ルーツの検証によってこれらの療法の調査のための新しいシステムの枠組み、 同時に、覚醒、心像、 注意の調和、感情、記憶、そして相違したプロセスを経たマルチモーダルを通じて恒常性を保持するための個人と社会生活の調整においての音楽の役割の紹介に努める。出発点として、Damasios Edelman氏の研究、そして他の現代の神経学の先駆者について、また、 恒常性とマルチモーダルの活動的な精神的生活の見地からの人類の生活のプロセス、そしてEdelman氏の“主意識”とDamasio氏の “中核的自己” の充満度について言及する。これらの複雑な相互関係の包含について、また、自発性とマルチモーダルをこれらの関係と噛み合わせるための音楽独特の性質が考察される。基礎的科学と臨床においてこれらの見解を評価し将来の研究を促すための提案がなされた。キーワード：音楽、マルチモーダル、イメージ、恒常性、意識、音楽療法 Korean음악의 다중 심상: 음악적 개입의 기초를 이루는 유효 요소와 장치들 Harry Ballan, Anna Abraham 임상의들과 연구자들은 다양한 임상 상황에서 심상 유도 음악(GIM)과 유사한 치료법들의 효능에 대한 강력한 증거들을 제시해왔다. 그러나 이 과정에서 효과적인 요소들을 식별할 수 있는 이론적 토대는 여전히 부족하다. 본 연구는 비유 과정(analogous processes), 기억, 정서, 주의 개입(attentional engagement), 각성(arousal), 심상(imagery) 같은 다중 접근법(multimodality)을 통해 항상성(homeostasis)을 유지하기 위해서 개인 생활 및 사회생활의 규제에서 음악이 하는 역할 뿐만 아니라 생물학적 근거를 조사함으로써 해당 치료법들에 대한 새로운 체계적 토대를 도입하려고 한다. Edelman, Damasio, 그리고 현대 신경 과학의 지도자들의 연구를 출발점으로, 항상성과 다중접근법(multimodality)을 우리의 활발한 정신생활과 관련된 인간의 일상 과정뿐 만 아니라 Edelman의 일차의식(primary consciousness)과 Damasio의 핵심 자아(core self)에도 꼭 필요한 것으로 나타났다. 음악이 다양한 측면에서 이런 연관관계에 개입할 수 있는 독특한 경향성이 있다는 것 뿐 만 아니라 또한 복잡한 교차적 연관관계가 갖는 의의도 고려해야 한다. 본 연구는 기초 과학과 임상현장 두 영역에서 이루어 질 수 있는 추가 연구에 대한 제안 및 평가에 대해 제안한다. 키워드: 음악, 다중의(multimodal), 심상, 항상성, 의식, 음악 치료
Importance
Autism spectrum disorder (ASD) is a highly prevalent disorder, and community psychiatrists are likely to treat many individuals with ASD during their clinical practice. This clinical case challenge describes a routine evaluation of irritability and self-injury in a preschool-aged child who meets the criteria for ASD. The case also illustrates the importance of known risk factors for ASD, such as chromosomal deletion and prematurity. This clinical neuroscience article seeks to educate the clinician of current avenues of research that can inform and may already affect clinical practice for this patient, while providing a preview of research that may yield biological treatments for ASD within the next decade.
Observations
A diagnosis of ASD is defined behaviorally; therefore, many genetic and environmental risk factors, working singly or in concert, are linked to ASD. The prenatal period of brain development is particularly sensitive to risk factors such as gene mutation or drug exposure that affect brain development and circuitry formation. Currently, neuroimaging researchers can detect changes in brain connectivity of children with ASD as young as 6 months, followed by an atypical trajectory of brain development through preschool age and ongoing connectivity inefficiencies across the lifespan. Animal and cellular model systems have provided a means for defining the molecular and cellular changes associated with risk factors for ASD. The ability to connect specific treatments to particular subgroups of people with ASD is the defining hope of precision medicine initiatives.
Conclusions and Relevance
The advent of next-generation sequencing technology, advanced imaging techniques, and cutting-edge molecular techniques for modeling ASD has allowed researchers to define ASD risk-related biological pathways and circuits that may, for the first time, unify the effects of disparate risk factors into common neurobiological mechanisms. The path from these mechanisms to biological treatments that improve the lives of individuals with autism remains unclear, but the cumulative output of multiple lines of research suggests that subtyping by genetic risk factors may be a particularly tractable way to capitalize on individual differences amenable to specific treatments.
Lay summary:
In this article, we summarize the themes discussed at the INSAR Special Interest Group (SIG) on Implementing and Evaluating Community-Based Early Intervention. Priorities for moving the field forward identified in the SIG included the need for (a) formal theories to guide the development and evaluation of interventions, (b) pilot evaluations that investigate feasibility and acceptability of interventions, (c) methodologies that allow us to determine for whom different interventions bring most benefit and why this is so, (d) strategies to include community members and other stakeholders in the process of developing and evaluating interventions, and (e) understanding of factors that make interventions more likely to be adopted and successfully implemented in the real world.
Background
Preliminary studies have indicated that music therapy may benefit children with autism spectrum disorders (ASD).
Objectives
To examine the effects of improvisational music therapy (IMT) on social affect and responsiveness of children with ASD.
Design
International, multicentre, three-arm, single-masked randomised controlled trial, including a National Institute for Health Research (NIHR)-funded centre that recruited in London and the east of England. Randomisation was via a remote service using permuted blocks, stratified by study site.
Setting
Schools and private, voluntary and state-funded health-care services.
Participants
Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent or guardian who provided written informed consent. We excluded children with serious sensory disorder and those who had received music therapy within the past 12 months.
Interventions
All parents and children received enhanced standard care (ESC), which involved three 60-minute sessions of advice and support in addition to treatment as usual. In addition, they were randomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESC alone, over 5 months in a ratio of 1 : 1 : 2.
Main outcome measures
The primary outcome was measured using the social affect score derived from the Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment. Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and 12 months (higher scores indicated greater impairment).
Results
A total of 364 participants were randomised between 2011 and 2015. A total of 182 children were allocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocated to ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) in the intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171 (94.0%) received it. From baseline to 5 months, mean scores of ADOS social affect decreased from 14.1 to 13.3 in music therapy and from 13.5 to 12.4 in standard care [mean difference: music therapy vs. standard care = 0.06, 95% confidence interval (CI) –0.70 to 0.81], with no significant difference in improvement. There were also no differences in the parent-rated social responsiveness score, which decreased from 96.0 to 89.2 in the music therapy group and from 96.1 to 93.3 in the standard care group over this period (mean difference: music therapy vs. standard care = –3.32, 95% CI –7.56 to 0.91). There were seven admissions to hospital that were unrelated to the study interventions in the two IMT arms compared with 10 unrelated admissions in the ESC group.
Conclusions
Adding IMT to the treatment received by children with ASD did not improve social affect or parent-assessed social responsiveness.
Future work
Other methods for delivering music-focused interventions for children with ASD should be explored.
Trial registration
Current Controlled Trials ISRCTN78923965.
Funding
This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 59. See the NIHR Journals Library website for further project information.