Music Interventions

Objectives: This study aimed to investigate the efficacy of music therapy (MT) in children with autism spectrum disorder (ASD) in the Chinese population through a meta-analysis.

Setting: We performed a systematic review according to the PRISMA guidelines. A systematic and comprehensive search was conducted across five databases: PubMed, Web of Science, Chinese Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, and Wanfang Database, up to the end of September 2024, that administered MT to children with ASD. Continuous variables were reported as standardized mean differences (SMD) accompanied by 95% confidence intervals (CIs). All analyses were carried out using the Stata statistical software package version 16.0.

Results: Twenty-three studies were included in our meta-analysis. The results showed that MT significantly decreased the total ATEC (autism treatment evaluation checklist) score (SMD = -2.52, 95% CI: -3.69 ~ -1.35, P < 0.001), ABC (autism behavior checklist) (SMD = -1.07, 95% CI: -1.52 ~ -0.61, P < 0.001), and CARS (childhood autism rating scale) score (SMD = -1.50, 95% CI: -2.26 ~ -0.74, P < 0.001). Specifically, MT significantly improved communication skills (SMD = -1.10, 95% CI: -1.54 ~ -0.66, P < 0.001), social interaction skills (SMD = -1.69, 95% CI: -2.59 ~ -0.78, P < 0.001), language ability (SMD = -1.15, 95% CI: -1.56 ~ -0.74, P < 0.001), and cognitive function (SMD = -1.80, 95% CI: -2.73 ~ -0.87, P < 0.001) compared to the control group.

Conclusion: MT can improve communication skills, social interaction skills, language ability, and cognitive function in children with ASD disorders in the Chinese population.

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Background: Autism Spectrum Disorder (ASD) affects one in 100
children worldwide, posing challenges in communication, social
interaction, and behavior. While music therapy (MT) shows promise in
improving these areas, its comprehensive impact remains underexplored.
The study evaluates the research question of whether MT has effects on
key developmental outcomes in children with ASD.

Method: This systematic review included randomized controlled and
quasi-randomized trials published in English. Searches were conducted
in PubMed and Cochrane databases. Participants were children with
ASD. The intervention focused on music therapy, with control groups
receiving standard therapy or placebo. Key outcomes included social
interaction, communication, adaptive behavior, autism functioning, global
improvement, and quality of life.

Results: 14 studies on MT for children with ASD showed varied
results. Intervention periods varied between 5 days and 8 months, with
frequencies ranging from twice daily to once weekly. Key effects included
improvements in social interaction, verbal and nonverbal communication,
global functioning, and quality of life at home and school.

Conclusions: Future research should focus on robust methodologies,
larger samples, and longer follow-ups. Investigating the effectiveness of
MT group versus individual interventions offers an important direction for future research.

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Background: Children with autism spectrum disorder (ASD) experience deficits in social skills. Music therapy (MT) has been used as a therapeutic aid for clinical disorders. This study aims to explore the effect of MT on the social skills of children with ASD and to provide evidence for clinical intervention in the social skills of children with ASD.

Methods: Children with ASD who were admitted to the Department of Children's Health Care of Zhongshan Torch Development Zone People's Hospital from April 2023 to March 2024 were continuously recruited and assigned to the experimental group and the control group by random number table. The control group received standard care only, while the experimental group added MT to standard care. The MT program is led by an occupational therapist and combines social skills training with musical activities. The training was conducted in small groups of 3–5 children for 30 minutes, three times a week for 12 weeks. The Social Responsiveness Scale (SRS-2), the Autism Treatment Evaluation Checklist (ATEC), and the Gesell Development Schedules (GDS) were performed before and after the intervention.

Results: A total of 29 children with ASD were included and randomly assigned to the MT group (n = 15) and the control group (n = 14). All participants completed the whole treatment protocol. There was no significant difference in the scores of SRS-2, ATEC, and GDS between the two groups before intervention. After 12 weeks of intervention, the scores of SRS-2 of the MT group were decreased in the social communication subscale (P < 0.05 compared to baseline and the control group) and total scores (P < 0.05 compared to baseline and the control group). The score of the ATEC scale of the MT group decreased in the speech/language/communication subscale (P < 0.05 compared to baseline and the control group), the sociability subscale (P < 0.05 compared to baseline and the control group), and the total score (P < 0.05 compared to baseline). The development quotient score of the social domain of GDS in the MT group was significantly higher than that before intervention (P < 0.05) and that in the control group (P < 0.05).

Conclusion: This study suggests that MT could effectively improve the social skills of children with ASD, and has a positive effect on language ability. MT has the potential to be an effective complement to regular social skill training.

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Abstract: Autism spectrum disorder (ASD) affects social interaction, communication, and learning, with its prevalence continuing to rise, and music therapy (MT) has shown promise in improving social interactions and communication skills in individuals with ASD. This systematic review explores the relationship between ASD and music therapy, examining factors that influence its effectiveness in children. A systematic review of randomized controlled trials (RCTs) published between 2009 and 2024 was conducted to assess the effects of music therapy on children with autism. Studies were retrieved from databases such as PubMed and Google Scholar, with the final search completed by October 1, 2024, and only RCTs that evaluated music's impact on ASD and reported relevant outcomes were included, while non-RCTs, studies with a high risk of bias, and duplicates were excluded. A total of nine RCTs involving 1,327 children with ASD, aged 2-12, were analyzed; these studies assessed various music therapy interventions lasting from two weeks to eight months, with sessions occurring one to three times per week. Findings were mixed, as four studies with 449 participants reported significant improvements in social communication skills, while three larger studies with 715 participants found no significant changes in primary social outcomes but noted improvements in specific aspects of social responsiveness, and two smaller studies with 59 participants reported notable enhancements in verbal production and emotional responsiveness. Music therapy has been recognized as a beneficial intervention for improving health outcomes across various conditions, including mental health disorders, and this review highlights its potential in autism, particularly in enhancing cognitive processing, emotional responses, and social communication; however, while the findings are promising, further research with larger sample sizes and extended study durations is necessary to validate these effects.

Conclusions: Music therapy (MT) is an intervention that has been widely used to enhance health outcomes for individuals with many different conditions, including mental health disorders. This study aimed to assess the impact of music therapy on autism patients by reviewing recent research. Some of the studies included in this review evaluated social communication skills among autism patients. The results consistently indicated that music therapy affected not only social communication and responsiveness but also emotional and motivational behaviors. Although the different types of interventions yielded varying outcomes, the overall findings suggested that music therapy leads to significant improvements in patients with autism. However, larger sample sizes and longer durations of study are needed to further validate these results.

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Abstract: The prevalence of autism, especially in children, calls for professionals to develop more effective therapies for treatment. Music therapy has been used for the treatment of Autism Spectrum Disorders (ASDs) since 1940s, although its treatment effect remains to be discussed. The current review aims to investigate the techniques used by literatures in this domain and to determine the evidence base for music therapy in intervention for children with ASD. After searching relevant database, a total of 217 articles were identified and 17 of them met the review’s inclusion criterion. DSP method is wildly used in music therapy, with various ways to include the musical elements in treatment. In general, music interventions were found to have treatment effect in areas of communication, socialization and behavior of children with ASD. The implications of these findings in terms of the use of music interventions, issues related to generalization and future direction are discussed.

Results: The current research identified 17 experimental studies that assessed the effectiveness of music interventions for individuals with autism, aiming to enhance communication, socialization, and behavioral skills. These studies align with Kaplan and Steele’s (2005) findings, which highlighted that the majority of music therapy goals for autism focus on language, communication, and behavioural/psychosocial aspects. Throughout the review, several factors emerged that could potentially influence the effectiveness of these interventions. These factors include the specific music techniques employed, the context in which the interventions occur, the training of those delivering the interventions, the characteristics of the participants, as well as considerations of generalization and maintenance of skills learned. Evaluating these factors is vital for understanding how to optimize music interventions for individuals with autism.

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Summary: Music therapy attempts to facilitate communication and expression – core problems for autistic people – through the development of experiences and relationships mediated by music. This commentary assesses a Cochrane Review of the effects of music therapy, compared with placebo or standard care, for autistic people, and its conclusion that music therapy is probably associated with an increased chance of global improvement and perhaps a slight increase in quality of life and reduction in total autism symptom severity in the short to medium term. The review was not able to examine longer-term effects as the longest follow-up period was 12 months. The certainty of the evidence was graded from moderate to very low, and therefore the results need to be viewed with caution.

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Abstract: 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).

Results: The evidence compiled in this review suggests that music therapy is probably associated with an increased chance of global improvement, and likely results in a small improvement in quality of life and a large improvement in total autism symptom severity immediately post‐intervention. It may also improve social interaction and non‐verbal communication during the intervention but not after the intervention. The evidence for verbal communication is uncertain. The evidence in our review also suggests that music therapy may improve adaptive behaviour in autistic children during the intervention but not after the intervention, and identity formation in autistic children and adolescents measured in the period of one to five months after the end of the intervention, but not immediately after the intervention.

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Abstract: The prevalence of autism spectrum disorders (ASD) is globally increasing, and the current available interventions show variable success. Thus, there is a growing interest in additional interventions such as music therapy (MT). Therefore, we aimed to provide a comprehensive and systematic review of music and people with, or at risk of, ASD. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and used PubMed, PsycINFO, and Web of Science as databases, with “music”, “music therapy”, “autism spectrum disorder”, and “ASD” as search terms. Among the identified and screened articles, 81 out of 621 qualified as scientific studies involving a total of 43,353 participants. These studies investigated the peculiarities of music perception in people with ASD, as well as the effects of music and MT in this patient group. Most of the music-based interventions were beneficial in improving social, emotional, and behavioural problems. However, the availability of studies utilizing a rigorous randomized controlled trial (RCT) design was scarce. Most of the studies had a small sample size, and the applied therapeutic and scientific research methods were heterogeneous.

Results: The current systematic review demonstrates that the perception of music in people with ASD differs from the music perception in neurotypical controls. Additionally, it shows that music and MT can be used as a therapeutic tool in the management of ASD.

People with ASD seem to have a superior ability of pitch memory and recognition compared to normal controls.

When MT was utilized as an adjunct for managing ASD or ASD symptoms, recognition and understanding of the emotional, communicative, and social aspects of music was elevated, attention was heightened, and motivation for physical exercising was increased. Moreover, music and MT might prevent ASD traits during pre-birth, support the child-parent relationship, and improve movement coordination, social communication, interaction and attention, and overall ASD symptoms in people with, or at risk for, ASD. Music and MT had a beneficial effect on biological parameters. Similar positive results were reported by studies that tested MT in combination with DMT. However, these findings do need to be interpreted regarding of the methodological issues and the potential for publication bias (Thornton and Lee 2000).

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Abstract: In a previously published multiple case study in which 10 children on the autism spectrum were offered the “Papageno Music Therapy Program” (PMTP), a favorable development was found with regard to social interaction. As an extension of our previous study, we investigate if the progress can also be observed in a larger group, and whether these developments are generalized to other situations.

Results: This study confirmed earlier research into the effects of PMTP on this group: Improvements in social interaction were visible during the course of the therapy. Informants observed this improvement not only within, but also outside the therapeutic setting. Overall, there were sufficient indications for PMTP having a positive effect on social behavior that warrant further evaluation through a controlled study.

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Abstract: The present study aims to compare the effects of listening to music tuned to 440 Hz and music tuned to 432 Hz on sleep in patients with spinal cord injuries.

Results: After listening to music at 432 Hz there was a significant improvement in sleep scores (+3.6, p=0.02), while there was no improvement in sleep scores listening to music at 440 Hz (-1.50, p=0.34).

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Abstract: To identify differences in vital parameters and perceptions after listening to music at different frequencies, 440 Hz versus 432 Hz.

Conclusions: The data suggests that 432 Hz tuned music can decrease heart rate more than 440 Hz tuned music.

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Abstract: To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer.

Conclusions: This systematic review indicates that music interventions may have beneficial effects on anxiety, pain, fatigue, and QoL in people with cancer.

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Abstract: To investigate the effect of live and recorded perioperative music therapy on anesthesia requirements, anxiety levels, recovery time, and patient satisfaction in women experiencing surgery for diagnosis or treatment of breast cancer.

Conclusions: Including music therapy as a complementary modality with cancer surgery may help manage preoperative anxiety in a way that is safe, effective, time-efficient, and enjoyable.

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Abstract: Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients; however its efficacy for people with CHD needs to be evaluated.

Conclusions: This systematic review indicates that listening to music may have a beneficial effect on anxiety in persons with CHD, especially those with a myocardial infarction. Anxiety-reducing effects appear to be greatest when people are given a choice of which music to listen to. Furthermore, listening to music may have a beneficial effect on systolic blood pressure, heart rate, respiratory rate, quality of sleep, and pain in persons with CHD.

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Abstract: To evaluate the scientific foundation for the implementation of a complementary therapy, harp playing.

Conclusions: Subjects in this study experienced decreased pain and anxiety with the harp intervention, and slight reductions in physiologic variable values.

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