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Music in Intervention for Children and Adolescents with Autism: A Meta-Analysis

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Abstract

This meta-analysis of 12 dependent variables from 9 quantitative studies comparing music to no-music conditions during treatment of children and adolescents with autism resuited in an overall effect size of d = .77 and a mean weighted correlation of r = .36 (p = .00). Since the confidence interval did not include 0, results were considered to be significant. All effects were in a positive direction, indicating benefits of the use of music in intervention. The homogeneity Q value was not significant (p = .83); therefore, results of included studies are considered to be homogeneous and explained by the overall effect size. The significant effect size, combined with the homogeneity of the studies, leads to the conclusion that all music intervention, regardless of purpose or implementation, has been effective for children and adolescents with autism. Included studies are described in terms of type of dependent variables measured; theoretical approach; number of subjects in treatment sessions; participation in and use, selection, and presentation of music; researcher discipline; published or unpublished source; and subject age. Clinical implications as well as recommendations for future research are discussed.
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... (para. 3) Furthermore, the possible benefits of music for aspects of communication among individuals on the spectrum are supported through empirical research and academic literature (e.g., El Mogharbel et al., 2006;Eren, 2015;Geretsegger et al., 2014;Hillier et al., 2016;Lim, 2012;Wan et al., 2010;Whipple, 2004). ...
... Music activities can be beneficial for improving social communication skills (Whipple, 2004). One example is a percussion discussion. ...
... Using music in therapeutic environments may provide engaging opportunities for communication (LaGasse, 2012;Whipple, 2004). Musical activities and materials may support functional language, academic language, and social communication goals and can be utilized by music therapists to help improve communication among adolescents on the autism spectrum (Kern et al., 2013;Lim, 2012;Wan et al., 2010). ...
Article
Adolescents on the autism spectrum may experience challenges with multiple domains of communication that impact their quality of life. Both music therapists and speech-language pathologists (SLPs) implement activities to address these challenges. Empirical evidence suggests that incorporating music into treatment can be an effective way to improve communication. The purpose of this article is to provide suggestions for music therapists assisting adolescents on the autism spectrum to improve their communication skills and ways to collaborate with SLPs in doing so. In this paper, we discuss interprofessional collaborative models (e.g., interdisciplinary, transdisciplinary) and competencies (e.g., coordination, adaptability), as well as music-based clinical experiences that appeal to adolescents, and target improvement of communication skills for learners with complex communication needs.
... As anecdotal reports outside her study design suggest, some non-verbal children developed initial language skills. In a meta-analysis of nine quantitative studies conducted with children and adolescents with ASD, Whipple found a significant average effect strength of d = 0.77 (Whipple 2004). She concluded that all musical intervention was effective, regardless of the purpose or the form of implementation. ...
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Music as a non-verbal form of communication and play addresses the core features of autism, such as social impairments, limited speech, stereotyped behaviors, sensory-perceptual impairments, and emotional dysregulation; thus music-based interventions are well established in therapy and education. Music therapy approaches are underpinned by behavioral, creative, sensory-perceptional, developmental, and educational theory and research. The effectiveness of music therapy in the treatment of children with autism spectrum disorder (ASD) is reflected by a huge number of studies and case reports; current empirical studies aim to support evidence-based practice. A treatment guide for improvisational music therapy provides unique interventions to foster social skills, emotionality, and flexibility; in developmental approaches, the formation of interpersonal relationships is key. Since ASD is a lifelong neurodevelopmental condition, music therapy is also appropriate in the treatment of adults with intellectual disability. Diagnostic approaches using musical-interactional settings to assess ASD symptomatology are promising, especially in non-speakers.
... Many of these studies concluded that music interventions positively impact mood and anxious or depressive symptoms in both children (Kim and Stegemann, 2016;Yinger and Gooding, 2015;Kemper and Danhauer, 2005) and adults (Carr et al., 2013;van der Wal-Huisman et al., 2018). Reviews of the evidence have suggested that Music therapy may improve mental health in children and adolescents and communication in children with autistic spectrum disorder (Gold et al., 2007;Whipple, 2004). In the same way, clinical reports and pre-experimental studies have suggested that Music therapy may be an effective intervention for adult patients with mental health problems across the world. ...
Article
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Music is a crucial element of everyday life and plays a central role in all human cultures: it is omnipresent and is listened to and played by persons of all ages, races, and ethnic backgrounds. But music is not simply entertainment: scientific research has shown that it can influence physiological processes that enhance physical and mental wellbeing. Consequently, it can have critical adaptive functions. Studies on patients diagnosed with mental disorders have shown a visible improvement in their mental health after interventions using music as primary tool. Other studies have demonstrated the benefits of music, including improved heart rate, motor skills, brain stimulation, and immune system enhancement. Mental and physical illnesses can be costly in terms of medications and psychological care, and music can offer a less expansive addition to an individual's treatment regimen. Interventions using music offers music-based activities in both a therapeutic environment (Music therapy) with the support of a trained professional, and non-therapeutic setting, providing an atmosphere that is positive, supportive, and proactive while learning non-invasive techniques to treat symptoms associated with various disorders – and possibly modulate the immune system.
... Meta-analizu o utjecaju MT na osobe s PSA provela je Whipple, a pregled je uključivao 10 eksperimentalnih studija koje su uspoređivale utjecaj glazbe (od MT do primjene pozadinske glazbe) i neglazbenih intervencija na nepoželjna ponašanja i socijalnu interakciju. 42 Sudionici su bile osobe s PSA u dobi od 2,5 do 21 godine, a uzorci veličine od 1 do 20 sudionika. Rezultati su pokazali značajan utjecaj glazbenih uvjeta u odnosu na neglazbene. ...
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Social communication disorder is one of the main characteristics of a person with autism spectrum disorder (ASD). Due to the fact, the attention of contemporary therapeutic approaches is increasingly focused on the conceptualisation of different methods aimed at initiating and supporting different aspects of communication in this population. In that sense, the use of music therapy (MT) has been considered as a complementary therapeutic method since music is based on universal language and requires interaction between two or more people. Also, certain scientific and empirical studies have shown that persons with ASD are interested in music, with often intact or even superior musical hearing, melody memory, and understanding of music, melody, and rhythm structure. Based on these findings, the aim of this study was to define the complex interaction between MT and social communication in persons with ASD. For this purpose, an overview of current researches in this area was carried out by using quotation databases like WoS, Scopus, EBSCO, Google Scholar etc. A review of the literature showed that most of MT interventions had a positive impact on the various elements of social communication such as: verbal and nonverbal communication, vocalization, joint attention, eye contact, concentration, cooperation and interactive behaviour in persons with ASD.
... The authors conclude that the interpersonal dynamics amongst teachers, pupils, and parents influence learning outcomes, but also noted biases including the restriction to violin teaching and learning and other potential biases arising from the sampling strategy [6]. Further evidence for beneficial effects of musical learning on the social development of children with social disorders is reported from numerous studies in the field of music therapy [14][15][16][17][18]. ...
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Learning to play a musical instrument is associated with different, partially conflicting emotions. This paper describes the development and psychometric properties of the Emotions while Learning an Instrument Scale (ELIS). In a longitudinal study with 545 German elementary school children factorial structure and psychometric properties were evaluated. Exploratory and confirmatory factor analyses confirmed a two-factor solution measuring Positive musical Emotions while Learning an Instrument (PELI) and Negative Emotions while Learning an Instrument (NELI). Both subscales yielded scores with adequate internal reliability (Cronbach’s α = .74, .86) and relatively stable retest reliabilities over 18 months ( r = .11 -.56). Preliminary evidence of congruent and divergent validity of the subscales is provided. Implications for future research of musical emotional experiences in children are discussed.
... A literature search was conducted to identify studies published prior to December 2020 which explored the relationship between music and food intake. To confirm databases, keywords for a literature search, as well as selection criteria for filtering eligible studies, and previous meta-analyses with relevant topics were referred [49][50][51][52][53][54][55][56]. There were four relevant databases identified, PsycINFO, Web of Science, PubMed, and ProQuest Dissertations and Theses (PQDT), and these were used to conduct our literature search. ...
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Food intake has been shown to be related to several environmental factors including the presence of music. However, previous findings of the relationship between music and food intake are inconsistent. In the present study, a systematic review and meta-analysis was conducted to quantitatively review the extent to which music is associated with food intake as well as to investigate potential moderators that might have contributed to the heterogeneity of the existing findings. Literature was searched on four databases (i.e., PsycINFO, Web of Science, PubMed, and ProQuest Dissertations and Theses) and Google Scholar. Nine articles published from 1989 to 2020 met our inclusion criteria. A meta-analysis was carried out via a three-level random-effects model. The overall effect size (i.e., Hedges’ g) was 0.19 (95% Confidence Interval: −0.003, 0.386; SE = 0.10, t = 1.99, p = 0.054), indicating a marginally significant but small effect size. Body Mass Index (F(1, 21) = 5.11, p = 0.035) was found to significantly contribute to the heterogeneity of effect sizes, with larger positive effects of music on food intake for individuals with higher BMI. However, music-related features did not significantly moderate the relationship between music and food intake. More experimental studies are needed to update the current meta-analysis and get a better understanding of this topic.
Article
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.
Chapter
The chapter focuses on expressive therapies and their importance for adolescents in addressing their mental health-related issues and promoting their well-being. It delineates the historical background of expressive therapies in counselling. Four main expressive therapies of art, music, dance, and drama therapy are explained in terms of their characteristics and stages of therapy. Techniques used in each therapy, their benefits, and application areas of each therapy are also discussed.
Chapter
It is difficult for autistic children to assess other people emotions and social behavior by observing non-verbal social cues, making the situation challenging to respond in a socially appropriate manner. Therefore, by utilizing the indirect means of contextual game and musical interactions in a group setting blended with social contexts from videos, autistic children may be able to gain better understanding of certain social cues and contexts. In this paper, computer programs utilized to design a game called “Mu-musicplay” and conduct social-context interaction to help children recognize and better identify emotions and social scenarios. This study was carried-out with three non-autistic children of age five as the subjects to obtain a baseline and foundation for a future study with autistic children. Results indicates that, while playing a game in which the children tried to recognize emotions from videos and music, they were better able to complete their task with the help of verbal guidance.
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Brain tumors are now the most common malignancy affecting children and the proportion of cancer deaths due to central nervous system tumors has doubled in the last 25 years (Bleyer 1999). Use of adjuvant chemotherapy has facilitated outstanding improvement in progression-free survival (PFS) and overall survival (OS) for children with primitive neuroectodermal– posterior fossa medulloblastoma. In contrast, tumors affecting infants and children less than 3 years of age at diagnosis remain difficult to treat effectively with surgery and adjuvant chemotherapy, though recent studies demonstrate the utility of adjuvant chemotherapy as a means to delay radiation during the critical neurodevelopmental window when radiation is associated with permanent neurocognitive sequelae. Other tumors, such as brainstem glioma and ependymoma, appear to be less sensitive or insensitive to the currently available chemotherapeutics.
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An attempt was made to develop a general music therapy treatment model for autistic children which is directed toward their specific areas of deficiencies and dysfunctioning. The model was based on results and experiences from an 8-month university research project. Four relevant treatment areas for music therapy with autistic children are included: (a) impaired language development, (b) impaired socio-emotional development, (c) impaired development of cognitive areas, and (d) perceptual motor disturbances. For each treatment area, aspects of pathology and diagnostic characteristics are outlined and sequences of pertinent music therapy techniques are identified.
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The purpose of the present study was to investigate the effect of a musical presentation of social story information on the behaviors of students with autism. Social stories are a means of incorporating an individual with autism's propensity toward visual learning with educationally necessary behavior modifications. Participants in the study were four first- and second-grade students with a primary diagnosis of autism attending an elementary school in eastern Iowa. A unique social story was created for each student that addressed a current behavioral goal. Subsequently, original music was composed using the text of the social story as lyrics. The independent variable for this study was one of three treatment conditions: baseline (A); reading the story (B); and singing the story (C). The reading and singing versions of the social stories were alternately presented to the students using the counterbalanced treatment order ABAC/ACAB. The dependent variable was the frequency with which the target behavior occurred under each condition of the independent variable. Data were collected for a period of 1 hour following presentation of the social story. Results from all four cases indicated that both the reading condition (B) and the singing condition (C) were significantly (p < .05) more effective in reducing the target behavior than the no-contact control condition (A). The singing condition was significantly more effective than the reading condition only in Case Study III. For the remaining case studies, the mean frequency of the target behavior was smaller during the singing condition, but not significantly so. These results suggested that the use of a musically adapted version of social stories is an effective and viable treatment option for modifying behaviors with this population.
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The literature on the use of music therapy in the treatment of autistic children contains many reports on clinical experiences and case studies, but few studies are available which apply objective methods of control, observation, and data reporting. The most comprehensive source for recent research findings concerning the we of music with autistic children is Euper’s article, “Early Infantile Autism.” After describing the syndrome in some detail and distinguishing autism from schizophrenia and other childhood disturbances, the author cites convincing evidence on the profound interest and frequent talent autistic children demonstrate in musical areas. Bergman and Escalona report a study where only one child out of thirty did not show deep interest in music. Rimland concludes, that musical interest and ability were “almost universal in autistic children.” References to other phenomena such as acute musical memory, perfect pitch, and intense listening interests have been made by Sherwin: Kanner, Schulman6 and others.
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This case study investigated the use of rhythm instruments to promote purposeful hand use in two preschool-aged girls with Rett syndrome. Various rhythm instruments and objects were used in individual 30 minute music sessions. Five pretest measures of hand involvement with these objects were taken followed by several weekly music sessions. Posttest measures were recorded and a Wilcoxon Matched fairs Signed-Ranks test was performed on the data. Results indicated a significant increase from pretest to posttest on all measures.
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This study investigated the effect of simulated training and music lesson reinforcement on the shopping skills of an autistic girl and her ability to transfer there skills to an actual grocery store setting. Behaviors chosen were (a) touching merchandise and (b) proximity to the therapist. Each skill was introduced individually while criteria became progressively more difficult over an 11 day period. Piano lessons were used as reinforcement for successful shopping trials. After 9 days the child was taken to a real grocery store where all selected inappropriate shopping behaviors had been completely eliminated.