'First Evidence' Music Improves Brain Connectivity in Autism

Music may help improve social communication as well as auditory-motor brain connectivity in children with autism spectrum disorder (ASD), new imaging research suggests.

In a study of 51 children with ASD, those who were randomly assigned to receive 2 to 3 months of an improvisational music intervention had significantly higher communication scores than those who received a nonmusic intervention.

They also had significantly greater resting-state functional connectivity between auditory and subcortical brain regions and between auditory and fronto-motor regions. In addition, the music-intervention group showed lower connectivity in visual regions, which are commonly found to be "over-connected" in those with autism.

"These findings are exciting and hold much promise for autism intervention," lead author Megha Sharda, postdoctoral fellow, International Laboratory for Brain, Music, and Sound Research, Department of Psychology, University of Montreal, Canada, said in a press release.

She told Medscape Medical News that although beneficial effects from music have been observed previously in individuals with ASD, it was exciting in this study to see these effects on the brain.

"When two people play together, there are so many important things going on with listening and interacting with each other; and as a result, it activates many parts of the brain. These are really key areas in autism and we were glad to study this in a vigorous design," Sharda said.

The findings were published online recently in Translational Psychiatry.

No Neuroscientific Evidence

"Music has been identified as a strength in people with [ASD]; however, there is currently no neuroscientific evidence supporting its benefits," the investigators write.

"Given its universal appeal, intrinsic reward value, and ability to modify brain and behavior, music may be a potential therapeutic aid in autism," they add.

In the current trial, which was conducted between April and December 2016 in Montreal, the researchers enrolled 51 children with ASD who were between the ages of 6 and 12 years (84% boys; mean age, 10.3 years).

All were randomly assigned to receive 8 to 12 weeks of either music (n = 26) or nonmusic (n = 25) interventions.

"The music intervention involved use of improvisational approaches through song and rhythm to target social communication," the investigators report. This approach used musical instruments, songs, and rhythmic cues.

"The nonmusic control [group] was a structurally matched behavioral intervention implemented in a nonmusical context," the researchers write. This approach relied on a play-based design and included both therapist attention and emotional engagement.

Both interventions emphasized self-expression and building relationships, and both were conducted in 45-minute individual weekly sessions.

A wide range of measurements were used, including parent-reported behavioral outcomes on the Children's Communication Checklist (CCC-2), the Social Responsiveness Scale (SRS-II), the maladaptive behavior subscale of the Vineland Adaptive Behavior Scales (VABS-MB), and the Beach Family Quality of Life Scale (FQoL). The Peabody Picture Vocabulary Test (PPVT-4) was also used to assess receptive vocabulary.

At baseline and postintervention, all participants underwent functional magnetic resonance imaging (fMRI) scans, which resulted in resting-state blood-oxygen-level-dependent (BOLD) images of the entire brain.

Better Communication, Brain Connectivity

Results showed significantly greater improvements in communication scores on the CCC-2 in the music-intervention group vs the control group (mean difference, 4.84; P = .01), as well as on FQoL (mean difference, 7.06; P = .01) and VABS-MB (mean difference, 0.08; P = .01) scores.

There were no significant between-group differences in scores on the SRS-II or PPVT-4.

However, the music group did show the following compared with the nonmusic group:

greater resting-state brain functional connectivity between auditory and subcortical regions (P < .0001);
greater connectivity between auditory and fronto-motor regions (P < .0001); and
lower connectivity between auditory and visual regions (P < .00001).

"This study provides the first evidence that 8-12 weeks of individual music intervention can indeed improve social communication and functional brain connectivity, lending support to further investigations of neurobiologically motivated models of music interventions in autism," write the investigators.

"The universal appeal of music makes it globally applicable and can be implemented with relatively few resources on a large scale in multiple settings, such as home and school," co-senior author Aparna Nadig, PhD, Centre for Research on Brain, Language, and Music, McGill University, Montreal, Canada, said in the release.

Sharda noted that although the study did not find changes specifically in autism symptoms themselves, this may be because currently "we do not have a tool sensitive enough to directly measure changes in social interaction behaviors."

She reported that the investigators are now working on developing such tools.

"Encouraging Finding"

"This is a good study that is, in some ways, one of the first to look at a well-defined intervention that's replicable while also looking at brain correlates" in children with ASD, Michael H. Thaut, PhD, professor of music, neuroscience, and rehabilitation sciences, University of Toronto, Ontario, Canada, told Medscape Medical News.

"Autism in general is quite under-researched, especially in relationship to what would be a good way to use music. That's not well understood. So this is a good study and a good first step," said Thaut, who is also director of the Music and Health Research Collaboratory at the University of Toronto.

He added that brain connectivity is a key neurological feature in this patient population, and that improved connectivity in the study "was an encouraging finding."

He also pointed out that although the patient population may seem small, "including 51 children with autism is actually quite a success. Getting these children to remain in a study can be difficult." He said that having a therapist involved "to train these kids" was key.

Asked if he has a take-home message for clinicians based on the study results, Thaut said he'd recommend that they "seriously consider using music" as a possible aid for patients with ASD.

"But it has to be done right," he stressed. "Music has been used for children for 50, 60 years and the research that has come out really hasn't shown much. This is really the first intervention study that has shown something. So I think it's important to look at how to use music."

He noted that there is a neurologic-music therapy model that clinicians can use "and maybe then tailor their intervention or recommendations around that."

The study was funded by the Canadian Institutes of Health Research and by a pilot grant from the Quebec Bioimaging Network. One study author was a contractual employee of Westmount Music Therapy during the course of the trial. Sharda, the other 7 study authors, and Thaut have disclosed no relevant financial relationships.

Transl Psychiatry. Published online October 23, 2018. Full text

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