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Music Therapy and Autism Ranking: Limited positive evidence

Music therapy using drums

Music therapy uses singing, live music making and/or composition techniques to encourage people to engage in spontaneous and creative musical activities.

Music therapy is based on the idea that all individuals have the ability to respond to music and sound and that this can lead to positive changes in behaviour and emotional well being.

The music therapist and client use a variety of percussion or tuned instruments, or their voices, to develop shared and interactive musical activities.

The client does not need musical skills to benefit from music therapy but the music therapist does need a high level of musical and therapeutic skill.

Music therapy is sometimes used alongside other therapies, for example dance therapy and in the creation of musical social stories.

Our Opinion

There is a limited amount of low quality research evidence which suggests that music therapy may be helpful in improving communication skills and, to a more limited extent, social skills, in some children and adolescents on the autism spectrum.

There is a need for more studies on music therapy with better design and larger samples. There is also a need for studies which examine whether or not music therapy works in real-world settings (such as the home or school), whether music therapy leads to meaningful everyday improvements in social functioning, and whether those effects are long lasting.

Disclaimer

Please read our Disclaimer on Autism Interventions


Audience

Music therapy is used with a wide range of people, including people on the autism spectrum, people with learning disabilities, people with mental health problems and people with physical disabilities.

For example, according to the Nordoff –Robbins website, accessed on 17 May 2016

“Through music therapy we support people with a range of challenges including autism and other learning difficulties, dementia, mental health problems, stroke, brain injury and depression. Some of the people we help have a life-threatening or terminal illness, such as cancer.” 

Aims and Claims

Aims

Music therapy is designed to address a wide range of physical, emotional, cognitive, and social needs.  For example, according to the American Music Therapy Association website, accessed on 17 May 2016,

“Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.

“Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients' abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words. Research in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people's motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings.”

Claims

There have been a number of claims for the use of music therapy with individuals on the autism spectrum. For example, the British Association of Music Therapy website, accessed on 24 May 2016, claims

“Music therapy can be very helpful for those with a diagnosis on the autistic spectrum. Involvement in music making can both stimulate and relax a person leading to very positive changes.

“Music therapy with children can:

  • help a child to listen
  • encourage spontaneous play
  • stir a desire to communicate
  • strengthen muscles and improve co-ordination
  • help the child to build relationships
  • improve concentration
  • provide a means of self expression
  • stimulate language development through songs and turn taking
  • excite imagination and creativity”

Key Features

According to the British Association of Music Therapists website, accessed on 19 May 2016,

“Music plays an important role in our everyday lives. It can be exciting or calming, joyful or poignant, can stir memories and powerfully resonate with our feelings, helping us to express them and to communicate with others.

“Music therapy uses these qualities and the musical components of rhythm, melody and tonality to provide a means of relating within a therapeutic relationship. In music therapy, people work with a wide range of accessible instruments and their voices to create a musical language which reflects their emotional and physical condition; this enables them to build connections with their inner selves and with others around them.

“Music therapists support the client’s communications with a bespoke combination of improvised or pre-composed instrumental music and voice, either sung or spoken. Individual and group sessions are provided in many settings such as hospitals, schools, hospices and care homes, and the therapist’s approach is informed by different theoretical frameworks, depending on their training and the health needs which are to be met”.

In practice music therapy uses singing, live music making and/or composition techniques to encourage people to engage in spontaneous and creative musical activities.

Music therapy is based on the idea that all individuals have the ability to respond to music and sound and that this can lead to positive changes in behaviour and emotional well being.

The music therapist and client use a variety of percussion or tuned instruments, or their voices, to develop shared and interactive musical activities.

The client does not need musical skills to benefit from music therapy but the music therapist does need a high level of musical and therapeutic skill.

Music therapy is sometimes used alongside other therapies, for example dance therapy and in the creation of musical social stories.

Music therapy is usually part of a multi-disciplinary programme, offering an enriched learning environment for the development of communication and other aspects of a child’s personality.  Music therapy should thus be considered as part of a broader programme of support and intervention to individuals on the autism spectrum.

Cost and Time

Cost

In the UK, music therapy provided via the NHS is free of charge at point of delivery to individuals and their families.

For music therapists working privately in the UK, charges vary between £45-£65 per session, although there may additional fees for the initial assessment and report writing etc.

Time

Like many other interventions, the length and frequency of music therapy will depend to a large extent on the needs of the individual client.

Music therapy sessions vary in length but usually last about 30 to 50 minutes. Sessions are held on a regular basis, often weekly. For children on the autism spectrum more frequent, shorter sessions may be easier for the child to access. Sessions can be provided in individual or group settings.

Risks and Safety

Hazards

There are no known adverse effects for music therapy.

Contraindications

There are no known contraindications (something which makes a particular treatment or procedure potentially inadvisable) for music therapy.

Suppliers and Availability

Suppliers

Music therapy is established as a profession in over 50 countries and a World Music Therapy Federation has been formed to promote the understanding, use and development of music therapy for the international mental health community.

In the UK many professional music therapists are employed by the National Health Service, local education authorities and social services or while others work freelance or in the not for profit sector.

Credentials

In the UK the profession was recognised by the National Health Service as a Profession Allied to Medicine in 1982, and in 1999 music therapy became a State Registered profession, and was incorporated, together with Art and Drama therapy as an amendment to the 1960 legislation governing the Council for the Professions Supplementary to Medicine.

Currently music therapy is governed by the Health and Care Professions Council (HCPC) where music therapists working in the public sector are required to maintain registration.

In the United States, a music therapist is most commonly designated by MT-BC (Music Therapist, Board-Certified). In Canada, the designation is MTA (Music Therapist Accredited/Musicotherapie Accreditee).

Related Suppliers and Availability


History

Music therapy as a formal discipline was developed in the USA in the mid 1940s, when Michigan State University and the University of Kansas began courses.

Music therapy was introduced to the UK in the 1950s and 60s by pioneer practitioners like Juliette Alvin, Paul Nordoff and Clive Robbins.

In the USA music therapy grew up initially as a palliative treatment for returning war veterans, and subsequently became more adapted as a behavioural intervention. In Europe, behavioural and developmental influences were present at the beginning, and music therapy had a remedial role in special education. However, music therapy in Europe, and particularly in the UK, has developed predominately as a psychotherapeutic intervention.

In all countries where music therapists are trained and qualified as clinical practitioners, music therapy is influenced by, and allied to music psychology, music in medicine, musicology, music science and technology, and some forms of sound therapy.

Current Research

We have identified 30 scientific studies of music therapy as an intervention for people on the autism spectrum published in peer-reviewed journals.

These studies included more than 400 individuals aged from 3 months to adult.

The majority of the studies reported improvements. For example,

  • Some of the studies (Boso et al, 2007) reported increased musical skills in some participants, for example, singing a song
  • Some of the studies (such as Edgerton, 1984) reported increased communication skills in some participants, for example, matching a fast rhythmic beat from the therapist
  • Some of the studies (such as Lim and Draper, 2011) reported improved speech production in some participants, for example, producing  repeated or echoed words
  • Some of the studies (such as Thompson et al, 2014) reported increased social interaction in some participants, for example, increased interactions with other family members
  • Some of the studies (such as LaGasse et al, 2014) reported increased joint attention skills and eye gaze in some participants.

A significant minority of the studies (such as Gattino et al, 2011) reported limited or mixed results.

Please note: we did not include some of the studies included in other reviews of music therapy such as the Cochrane review carried out by Geretsegger et al. (2014). For example, we did not include studies which have only been published as student dissertations (such as Arezina, 2011).

Status Research

There are a number of limitations to all of the research studies published to date. For example  

  • The majority of the studies had a small number of participants - between 1 and 8. One of the studies with a greater number of participants (Kim, 2008) had a dropout rate of 5 out of 15, that is, 33%.
  • In some of the studies (such as Aldridge et al, 1995) it is not clear how many, if any, of the participants were on the autism spectrum.
  • Some of the studies (such as Kaplan and Steele, 2005) were retrospective (where the study is planned once the intervention has taken place) or were not experimental in design (where the study is planned to test specified objectives).
  • Some of the studies (such as Dezfoolian et al, 2013) had no comparison control group (a group that gets a different treatment).
  • Some of the controlled studies (such as Ghasemtabar et al, 2015) were non-randomised (so the control group may have had different characteristics to the experimental group) and non-blinded (the researchers and participants knew who got which treatment).
  • Some of the studies (such as Saperston, 1973) did not establish adequate baseline measures before the intervention began (which makes it difficult to assess the significance of any reported changes).
  • Some of the studies (such as Gattino et al, 2011) did not use a structured, manualised protocol (a set of codified instructions which ensures the intervention is delivered the way it should be).
  • Some of the studies (such as Rosenblatt et al, 2011) used music therapy alongside a wide range of other interventions (which makes it difficult to assess the effectiveness or otherwise of each intervention).

 For a comprehensive list of potential flaws in research studies, please see "Why some research studies are flawed."

Ongoing Research

This page provides details of ongoing research into music therapy and people on the autism spectrum.

If you know of any other studies we should include please email info@researchautism.net with the details.

Future Research

Summary of Existing Research

There is a limited amount of low quality research evidence which suggests that music therapy may be helpful in improving communication skills and, to a lesser extent, social skills, in some children and adolescents on the autism spectrum.

The systematic Cochrane review undertaken by Geretsegger et al. (2014) reported “that music therapy may have positive effects on social interaction and communication skills of children with ASD.”

The review went on to report “However, these findings need to be corroborated by future research involving larger samples. ...As only short- to medium-term effects have been examined, it remains unknown how enduring the effects of music therapy on social interaction, communication, and related skills are in the long term.”

There some anecdotal reports from a variety of individuals from a variety of countries.

Recommendations for Future Research

There is a need for more studies on music therapy with better design and larger samples. There is also a need for studies which examine whether or not music therapy works in real-world settings (such as the home or school), whether music therapy leads to meaningful everyday improvements in social functioning, and whether those effects are long lasting.

According to Geretsegger et al (2014),

“Future research on music therapy for people with ASD will need to pay close attention to sample size and power. Sample sizes in all included studies were small, and test power was only discussed in three studies (Gattino 2011; Kim 2008; Thompson 2012a). Limited sample size remains a common problem in research on interventions for ASD. As there is a lack of studies for older individuals with ASD, research is needed examining effects of music therapy for adolescents and adults with ASD. Furthermore, we recommend that future trials on music therapy in this area should be: (1) pragmatic [work in the real world]; (2) parallel [where different participants are split into different groups, each which receives a different intervention]; (3) conscious of types of music therapy; (4) conscious of relevant outcome measures; and (5) include long-term follow-up assessments.

We agree with these recommendations and also the need to evaluate the impact of music therapy on everyday social functioning.

Studies and Trials

This section provides details of scientific studies into the effectiveness music therapy for people on the autism spectrum which have been published in English-language, peer-reviewed journals.You may be able to find more studies on music therapy in our publications database.

If you know of any other studies we should include please email info@researchautism.net with the details.

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Studies and Trials


Other Reading

This section provides details of other publications on this topic. If you know of any other publications we should include please email info@researchautism.net with the details.

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Other Reading


Personal Accounts

We have been unable to identify any personal anecdotes about the use of music therapy in people on the autism spectrum. If you know of any personal accounts we could include please email info@researchautism.net with the details.

Updated
19 Dec 2017
Last Review
01 Sep 2016
Next Review
01 Sep 2019