COMMENTARY

Music Therapy and Autism Spectrum Disorder: Any Lasting Benefit?

William T. Basco, Jr., MD, MS

Disclosures

October 20, 2017

Music Therapy for Children With Autism Spectrum Disorder

Because previous randomized trials have suggested positive benefits of music therapy on social and communication outcomes in patients with autism spectrum disorder (ASD), Bieleninik and colleagues[1] designed a study to determine whether music had long-term benefits for young children with ASD.

Children with ASD from nine countries, aged 4-7 years, were enrolled from 2011 to 2015, with follow-up up to 1 year after enrollment. The children were naive to music therapy for at least 12 months prior to enrollment. All study children received enhanced standard care. The children were randomly assigned to either a control group or to one of two active treatments—low-intensity, once-weekly music therapy or high-intensity (three times each week) music therapy. Each music therapy session, which lasted 30 minutes, was an improvisational session, in which the child and music therapist spontaneously created music together. Enhanced standard care involved the usual care for a child with ASD plus parental counseling. The investigators were blinded to subject group assignment.

Data collected at enrollment included the intelligence quotient (IQ) from standardized testing or an estimate of functioning for children who could not complete an IQ test. Parents also completed measures of the child's social responsiveness and quality of life for both the child and the family. The children were reassessed at 2, 5, and 12 months after randomization.

The primary outcome of interest was a measure of social affect, comparing the score at enrollment with the score at the end of 5 months of intervention. The individuals who rated the children varied from country to country, but all had received training on use of the social affect tool. The study randomly assigned 364 children, 182 to the control group and 182 to the treatment group (91 each to high-intensity and low-intensity music therapy). Similar numbers of children in each group completed the intervention and assessment.

The study was ended early after a planned interim analysis, so the results presented are limited relative to the intervention and follow-up period originally planned. With respect to the primary outcome, the treatment and control groups both experienced a slight reduction in social affect score, towards improvement. However, the difference in scores was only 0.06 (95% confidence interval, -0.70–0.81), indicating no significant difference in outcome between the music therapy and control groups. Similar differences were found when comparing just the high-intensity group or the low-intensity group versus the control group. Even among the secondary outcomes, the differences were limited. The investigators concluded that improvisational music therapy, when added to enhanced standard care, did not provide a benefit in social affect functioning for children with ASD beyond enhanced standard care alone.

Viewpoint

This is no doubt a very disappointing finding for parents and professionals who care for children with ASD. Finding any therapeutic option that improves the lives of these children and their families would be of great significance. In the discussion, the study authors make a very important point: It is difficult to ensure the fidelity of the intervention and assessment across multicenter sites when one has limited funding. For example, it would have been better for a single rater to evaluate every child (by video, for example) than to have a different evaluator at each site.

Nevertheless, the same limitation would be operating in any effort to widely implement music as a therapeutic option. Just because something proves effective in a very controlled clinical trial doesn't mean it will be as effective when implemented under less stringent parameters in day-to-day medical care. It was not the intention of the investigators to make this an implementation trial, but in some ways it is just that, given the variability of assessment from site to site. They also point out that theirs may not be the only outcome important to families when it comes to having their child participate in music therapy, and that is certainly something that shouldn't be completely discounted.

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