An international study finds the improvements from improvisational music therapy, on symptoms of autism, to be similar to those who do not receive music therapy.
Christian Gold from Uni Research in Bergen and his international team of co-researchers wanted to know if there is reliable evidence that music therapy produces lasting effects on core symptoms of autism.
Hence, in a new study published in JAMA the researchers enrolled 364 children from nine countries around the world and assigned them to either improvisational music therapy or enhanced standard care.
The researchers compared autism symptoms before and after therapy, based on the observation of a professional who did not know the children or what therapy they were receiving.
Although children tended to improve over time, this improvement was small, and it was similar whether or not children received music therapy.
Gold underlines the importance of further developing music therapy for children with autism.
Our trial demonstrated limited effects of music therapy as it is practiced today. It could mark the beginning of a new era of music therapy practice and research. We need to develop it further and determine what approach works best for whom.
Many of the children enjoyed the sessions
Half of the 364 children were invited to work with a trained music therapists either once a week or three times a week. This was mostly in a one-to-one setting, but sometimes family members were invited to join, and it was continued over 5 months.
Music therapy was provided in addition to enhanced standard care, which included parent counselling and any other therapies that children were already receiving.
The other half of the children received enhanced standard care but no music therapy.
The results were not what affected children, their parents, and their therapists were hoping to see.
We heard from many parents and from therapists that children enjoyed the music therapy sessions, and there were some who reported improvements, either in autistic symptoms or in related areas, Gold says.
However, based on the results of this study, we can say that such improvements were on average similar in those who received music therapy and in those who did not receive it. In my opinion, it is important to know this, and we should therefore welcome this negative trial.
A new understanding of the use of music therapy
According to Gold music therapy can be practiced in different ways, and new developments are already under way. These are directed at improving music therapy and at matching approaches and target groups.
Musical interactions can create affective involvement in children with autism and therefore have a motivational significance.
Karin Mössler, one of the co-researchers and a music therapist says children can experience enjoyment when making music as musical interactions might stimulate, coordinate and regulate their sensory and emotional experiences.
From infant research, we know that the regulation and coordination of such experiences, which can be affected in children with autism, are paving the way towards interactive communication, Mössler explains.
From a related project, they have seen that the musical and emotional attunement, which is defined as unique principle in improvisational music therapy, might be an important mechanism of change supporting the development of social abilities.
We have some indications that those children where therapists were able to allow for and participate in attunement processes improve more. Now we have to demonstrate that we can train music therapists to do that better, and that this leads to improvements in all children, not only those who were easier to contact already, Gold says.
A second development is directed at involving parents more actively so that musical interactions can be transferred to the families' everyday life.
This is both a policy priority in some countries and a wish of parents themselves. It is also a trend in other autism interventions because it may help to sustain and generalise across social contexts what children have learned in sessions, Gold says.
A third development could be that music therapy is more effective in some children than in others. But we still know too little about that.
Fourth, it could be that more sessions over a longer time period help more.
Children received on average 19 sessions over 5 months. This is quite little compared to usual practice, where it is often provided for several years.
Few therapies with documented effects for people with autism
Gold says that there have been many smaller studies looking at outcomes of music therapy for children with autism.
We had earlier summarised those studies that had the most rigorous research designs in a Cochrane review, which is regarded as a very reliable form of evidence summary, Gold says.
The summary of ten studies from around the world showed promising results, but they had their limitations.
All the previous studies were based on a small number of participants and examined effects only over a short time period, Gold explains.
For most therapies, the evidence base suffers from the same problems that I have described for previous music therapy trials.
Some interventions, especially those that work with behavioural conditioning to reinforce desired behaviours, have the reputation of having proven efficacy, but this is based on old studies that would not be adequate by today's standards.
Many trials are too small, too limited locally, and do not examine the outcomes and time periods that are relevant with methods that are reliable.
The pursuit of music or music therapy should perhaps not be guided primarily by the hope to reduce autism symptoms, but rather by the possibility to support the child's individual relational resources, musical interest and strengths.
Gold thinks there are two take-away messages for people with autism and those around them from this study:
- First, they should be sceptical of therapies that promise wonder cures without proper evidence.
- Second, they should perhaps seek to find the right social context where autistic symptoms are accepted and understood, instead of trying to remove those symptoms. It has long been noted that many people with autism have a special interest in music, says Gold.
It can be a way for them to express themselves, adds Mössler.
People with autism should be supported to pursue their interests, says Gold. But the pursuit of music or music therapy should perhaps not be guided primarily by the hope to reduce autism symptoms.