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Review
, 2014 (6), CD004381

Music Therapy for People With Autism Spectrum Disorder

Affiliations
Review

Music Therapy for People With Autism Spectrum Disorder

Monika Geretsegger et al. Cochrane Database Syst Rev.

Abstract

Background: The central impairments of people with autism spectrum disorder (ASD) affect social interaction and communication. Music therapy uses musical experiences and the relationships that develop through them to enable communication and expression, thus attempting to address some of the core problems of people with ASD. The present version of this review on music therapy for ASD is an update of the original Cochrane review published in 2006.

Objectives: To assess the effects of music therapy for individuals with ASD.

Search methods: We searched the following databases in July 2013: CENTRAL, Ovid MEDLINE, EMBASE, LILACS, PsycINFO, CINAHL, ERIC, ASSIA, Sociological Abstracts, and Dissertation Abstracts International. We also checked the reference lists of relevant studies and contacted investigators in person.

Selection criteria: All randomised controlled trials (RCTs) or controlled clinical trials comparing music therapy or music therapy added to standard care to 'placebo' therapy, no treatment, or standard care for individuals with ASD were considered for inclusion.

Data collection and analysis: Two authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated the pooled standardised mean difference (SMD) and corresponding 95% confidence interval (CI) for continuous outcomes to allow the combination data from different scales and to facilitate the interpretation of effect sizes. Heterogeneity was assessed using the I² statistic. In cases of statistical heterogeneity within outcome subgroups, we examined clients' age, intensity of therapy (number and frequency of therapy sessions), and treatment approach as possible sources of heterogeneity.

Main results: We included 10 studies (165 participants) that examined the short- and medium-term effect of music therapy interventions (one week to seven months) for children with ASD. Music was superior to 'placebo' therapy or standard care with respect to the primary outcomes social interaction within the therapy context (SMD 1.06, 95% CI 0.02 to 2.10, 1 RCT, n = 10); generalised social interaction outside of the therapy context (SMD 0.71, 95% CI 0.18 to 1.25, 3 RCTs, n = 57, moderate quality evidence), non-verbal communicative skills within the therapy context (SMD 0.57, 95% CI 0.29 to 0.85, 3 RCTs, n = 30), verbal communicative skills (SMD 0.33, 95% CI 0.16 to 0.49, 6 RCTs, n = 139), initiating behaviour (SMD 0.73, 95% CI 0.36 to 1.11, 3 RCTs, n = 22, moderate quality evidence), and social-emotional reciprocity (SMD 2.28, 95% CI 0.73 to 3.83, 1 RCT, n = 10, low quality evidence). There was no statistically significant difference in non-verbal communicative skills outside of the therapy context (SMD 0.48, 95% CI -0.02 to 0.98, 3 RCTs, n = 57, low quality evidence). Music therapy was also superior to 'placebo' therapy or standard care in secondary outcome areas, including social adaptation (SMD 0.41, 95% CI 0.21 to 0.60, 4 RCTs, n = 26), joy (SMD 0.96, 95% CI 0.04 to 1.88, 1 RCT, n = 10), and quality of parent-child relationships (SMD 0.82, 95% CI 0.13 to 1.52, 2 RCTs, n = 33, moderate quality evidence). None of the included studies reported any adverse effects. The small sample sizes of the studies limit the methodological strength of these findings.

Authors' conclusions: The findings of this updated review provide evidence that music therapy may help children with ASD to improve their skills in primary outcome areas that constitute the core of the condition including social interaction, verbal communication, initiating behaviour, and social-emotional reciprocity. Music therapy may also help to enhance non-verbal communication skills within the therapy context. Furthermore, in secondary outcome areas, music therapy may contribute to increasing social adaptation skills in children with ASD and to promoting the quality of parent-child relationships. In contrast to the studies included in an earlier version of this review published in 2006, the new studies included in this update enhanced the applicability of findings to clinical practice. More research using larger samples and generalised outcome measures is needed to corroborate these findings and to examine whether the effects of music therapy are enduring. When applying the results of this review to practice, it is important to note that the application of music therapy requires specialised academic and clinical training.

Conflict of interest statement

The authors of this review are clinically trained music therapists.

Christian Gold is an Associate Editor of the Cochrane Developmental, Psychosocial and Learning Problems Group, and has been involved in publications from two studies included in this review (Kim 2008;Thompson 2012a), none of which supported or influenced his work on this review.

Christian Gold and Karin Mössler's institute (GAMUT) received a grant to support the preparation of this manuscript from The Research Council of Norway (grant no. 213844, The Clinical Research and The mental Health Programmes). Support for the manuscript was also received through Monika Geretsegger's PhD Mobility Fellowship, which was funded by a grant from the Danish Council for Independent Research/Humanities (FKK) to Aalborg University.

Cochavit Elefant ‐ none known.

Figures

1
1
Study flow diagram.
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Forest plot of comparison: 1 Music therapy vs. 'placebo' therapy or standard care, outcome: 1.2 Communicative skills: non‐verbal.
1.1
1.1
Comparison 1 Music therapy vs. 'placebo' therapy or standard care, Outcome 1 Social interaction.
1.2
1.2
Comparison 1 Music therapy vs. 'placebo' therapy or standard care, Outcome 2 Communicative skills: non‐verbal.
1.3
1.3
Comparison 1 Music therapy vs. 'placebo' therapy or standard care, Outcome 3 Communicative skills: verbal.
1.4
1.4
Comparison 1 Music therapy vs. 'placebo' therapy or standard care, Outcome 4 Initiating behaviour.
1.5
1.5
Comparison 1 Music therapy vs. 'placebo' therapy or standard care, Outcome 5 Social‐emotional reciprocity.
1.6
1.6
Comparison 1 Music therapy vs. 'placebo' therapy or standard care, Outcome 6 Social adaptation.
1.7
1.7
Comparison 1 Music therapy vs. 'placebo' therapy or standard care, Outcome 7 Joy.
1.8
1.8
Comparison 1 Music therapy vs. 'placebo' therapy or standard care, Outcome 8 Quality of parent‐child relationship.

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