Emotion Perception in Music in High-Functioning Adolescents With Autism Spectrum Disorders

Getting the Feeling? The Salience of Music Emotion with a Cochlear Implant

OBJECTIVE

Music, like all forms of art, seeks to communicate emotional content to its audience. The signal provided by cochlear implants (CI) does not faithfully represent the psychophysical relationships inherent in music; however, it is unknown whether targeted musical emotions are conveyed through electric only stimulation with a cochlear implant.

METHODS

Twenty musical excerpts for which there was concordance among normal hearing (NH) listeners as to the emotion conveyed: (1) happy, (2) sad, (3) scary, or (4) peaceful were presented to cochlear implant (CI) subjects (n = 20) and age-matched NH controls (n = 8) through a specifically designed iPad application. The musical clips were original recordings of western music from various musical genres but not widely familiar to participants. Subjects also completed a music background questionnaire.

RESULTS

CI users identified the target emotion in only 57% of excerpts compared with NH listeners who correctly identified the target emotion in 76.9% of excerpts. Musical excerpts with the target emotion of happy were recognized in 84% of cases by CI users compared with 75% among NH controls while the remaining target emotions were much more difficult for CI users compared with NH raters. Length of CI experience, speech perception scores, and musical training or listening habits did not correlate with performance on this task.

CONCLUSIONS

Current CI technology and processing strategies do not convey the range of emotions conveyed in music as recognized by normal hearing subjects. This difficulty may explain the reported lack of interest many patients have in music after CI despite a passion for music before onset of hearing loss.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:2112-2119, 2025.

A randomized controlled trial of the efficacy of music therapy on the social skills of children with autism spectrum disorder

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.

Predictive processing of music and language in autism: Evidence from Mandarin and English speakers

Atypical predictive processing has been associated with autism across multiple domains, based mainly on artificial antecedents and consequents. As structured sequences where expectations derive from implicit learning of combinatorial principles, language and music provide naturalistic stimuli for investigating predictive processing. In this study, we matched melodic and sentence stimuli in cloze probabilities and examined musical and linguistic prediction in Mandarin- (Experiment 1) and English-speaking (Experiment 2) autistic and non-autistic individuals using both production and perception tasks. In the production tasks, participants listened to unfinished melodies/sentences and then produced the final notes/words to complete these items. In the perception tasks, participants provided expectedness ratings of the completed melodies/sentences based on the most frequent notes/words in the norms. While Experiment 1 showed intact musical prediction but atypical linguistic prediction in autism in the Mandarin sample that demonstrated imbalanced musical training experience and receptive vocabulary skills between groups, the group difference disappeared in a more closely matched sample of English speakers in Experiment 2. These findings suggest the importance of taking an individual differences approach when investigating predictive processing in music and language in autism, as the difficulty in prediction in autism may not be due to generalized problems with prediction in any type of complex sequence processing.

Musical Beat Perception Skills of Autistic and Neurotypical Children

Many autistic children show musical interests and good musical skills including pitch and melodic memory. Autistic children may also perceive temporal regularities in music such as the primary beat underlying the rhythmic structure of music given some work showing preserved rhythm processing in the context of basic, nonverbal auditory stimuli. The temporal regularity and prediction of musical beats can potentially serve as an excellent framework for building skills in non-musical areas of growth for autistic children. We examine if autistic children are perceptually sensitive to the primary beat of music by comparing the musical beat perception skills of autistic and neurotypical children. Twenty-three autistic children and 23 neurotypical children aged 6-13 years with no group differences in chronological age and verbal and nonverbal mental ages completed a musical beat perception task where they identified whether beeps superimposed on musical excerpts were on or off the musical beat. Overall task performance was above the theoretical chance threshold of 50% but not the statistical chance threshold of 70% across groups. On-beat (versus off-beat) accuracy was higher for the autistic group but not the neurotypical group. The autistic group was just as accurate at detecting beat alignments (on-beat) but less precise at detecting beat misalignments (off-beat) compared to the neurotypical group. Perceptual sensitivity to beat alignments provides support for spared music processing among autistic children and informs on the accessibility of using musical beats and rhythm for cultivating related skills and behaviours (e.g., language and motor abilities).

Links between musical beat perception and phonological skills for autistic children

Exploring non-linguistic predictors of phonological awareness, such as musical beat perception, is valuable for children who present with language difficulties and diverse support needs. Studies on the musical abilities of children on the autism spectrum show that they have average or above-average musical production and auditory processing abilities. This study aimed to explore the relationship between musical beat perception and phonological awareness skills of children on the autism spectrum with a wide range of cognitive abilities. A total of 21 autistic children between the ages of 6 to 11 years old (M = 8.9, SD = 1.5) with full scale IQs ranging from 52 to 105 (M = 74, SD = 16) completed a beat perception and a phonological awareness task. Results revealed that phonological awareness and beat perception are positively correlated for children on the autism spectrum. Findings lend support to the potential use of beat and rhythm perception as a screening tool for early literacy skills, specifically for phonological awareness, for children with diverse support needs as an alternative to traditional verbal tasks that tend to underestimate the potential of children on the autism spectrum.

Music for autism: a protocol for an international randomized crossover trial on music therapy for children with autism

The notion of a connection between autism and music is as old as the first reported cases of autism, and music has been used as a therapeutic tool for many decades. Music therapy holds promise as an intervention for individuals with autism, harnessing their strengths in music processing to enhance communication and expression. While previous randomized controlled trials have demonstrated positive outcomes in terms of global improvement and quality of life, their reliance on psychological outcomes restricts our understanding of underlying mechanisms. This paper introduces the protocol for the Music for Autism study, a randomized crossover trial designed to investigate the effects of a 12-week music therapy intervention on a range of psychometric, neuroimaging, and biological outcomes in school-aged children with autism. The protocol builds upon previous research and aims to both replicate and expand upon findings that demonstrated improvements in social communication and functional brain connectivity following a music intervention. The primary objective of this trial is to determine whether music therapy leads to improvements in social communication and functional brain connectivity as compared to play-based therapy. In addition, secondary aims include exploring various relevant psychometric, neuroimaging, and biological outcomes. To achieve these objectives, we will enroll 80 participants aged 6-12 years in this international, assessor-blinded, crossover randomized controlled trial. Each participant will be randomly assigned to receive either music therapy or play-based therapy for a period of 12 weeks, followed by a 12-week washout period, after which they will receive the alternate intervention. Assessments will be conducted four times, before and after each intervention period. The protocol of the Music for Autism trial provides a comprehensive framework for studying the effects of music therapy on a range of multidimensional outcomes in children with autism. The findings from this trial have the potential to contribute to the development of evidence-based interventions that leverage strengths in music processing to address the complex challenges faced by individuals with autism. Clinical Trial Registration: Clinicaltrials.gov identifier NCT04936048.

"But not the music": psychopathic traits and difficulties recognising and resonating with the emotion in music

Recognising and responding appropriately to emotions is critical to adaptive psychological functioning. Psychopathic traits (e.g. callous, manipulative, impulsive, antisocial) are related to differences in recognition and response when emotion is conveyed through facial expressions and language. Use of emotional music stimuli represents a promising approach to improve our understanding of the specific emotion processing difficulties underlying psychopathic traits because it decouples recognition of emotion from cues directly conveyed by other people (e.g. facial signals). In Experiment 1, participants listened to clips of emotional music and identified the emotional content (Sample 1, N = 196) or reported on their feelings elicited by the music (Sample 2, N = 197). Participants accurately recognised (t(195) = 32.78, p < .001, d = 4.69) and reported feelings consistent with (t(196) = 7.84, p < .001, d = 1.12) the emotion conveyed in the music. However, psychopathic traits were associated with reduced emotion recognition accuracy (F(1, 191) = 19.39, p < .001) and reduced likelihood of feeling the emotion (F(1, 193) = 35.45, p < .001), particularly for fearful music. In Experiment 2, we replicated findings for broad difficulties with emotion recognition (Sample 3, N = 179) and emotional resonance (Sample 4, N = 199) associated with psychopathic traits. Results offer new insight into emotion recognition and response difficulties that are associated with psychopathic traits.

Emotion recognition in autism spectrum disorder across age groups: A cross-sectional investigation of various visual and auditory communicative domains

Previous research on emotion processing in autism spectrum disorder (ASD) has predominantly focused on human faces and speech prosody, with little attention paid to other domains such as nonhuman faces and music. In addition, emotion processing in different domains was often examined in separate studies, making it challenging to evaluate whether emotion recognition difficulties in ASD generalize across domains and age cohorts. The present study investigated: (i) the recognition of basic emotions (angry, scared, happy, and sad) across four domains (human faces, face-like objects, speech prosody, and song) in 38 autistic and 38 neurotypical (NT) children, adolescents, and adults in a forced-choice labeling task, and (ii) the impact of pitch and visual processing profiles on this ability. Results showed similar recognition accuracy between the ASD and NT groups across age groups for all domains and emotion types, although processing speed was slower in the ASD compared to the NT group. Age-related differences were seen in both groups, which varied by emotion, domain, and performance index. Visual processing style was associated with facial emotion recognition speed and pitch perception ability with auditory emotion recognition in the NT group but not in the ASD group. These findings suggest that autistic individuals may employ different emotion processing strategies compared to NT individuals, and that emotion recognition difficulties as manifested by slower response times may result from a generalized, rather than a domain-specific underlying mechanism that governs emotion recognition processes across domains in ASD.

Music-Enhanced Emotion Identification of Facial Emotions in Autistic Spectrum Disorder Children: A Pilot EEG Study

The Autistic Spectrum Disorder (ASD) is characterized by a difficulty in expressing and interpreting others' emotions. In particular, people with ASD have difficulties when interpreting emotions encoded in facial expressions. In the past, music interventions have been shown to improve autistic individuals' emotional and social skills. The present study describes a pilot study to explore the usefulness of music as a tool for improving autistic children's emotion recognition in facial expressions. Twenty-five children (mean age = 8.8 y, SD = 1.24) with high-functioning ASD and normal hearing participated in the study consisting of four weekly sessions of 15 min each. Twenty-five participants were randomly divided into an experimental group (N = 14) and a control group (N = 11). During each session, participants in the experimental group were exposed to images of facial expressions for four emotions (happy, sad, angry, and fear). Images were shown in three conditions, with the second condition consisting of music of congruent emotion with the shown images. Participants in the control group were shown only images in all three conditions. For six participants in each group, EEG data were acquired during the sessions, and instantaneous emotional responses (arousal and valence values) were extracted from the EEG data. Inter- and intra-session emotion identification improvement was measured in terms of verbal response accuracy, and EEG response differences were analyzed. A comparison of the verbal responses of the experimental group pre- and post-intervention showed a significant (p = 0.001) average improvement in emotion identification accuracy responses of 26% (SD = 3.4). Furthermore, emotional responses of the experimental group at the end of the study showed a higher correlation with the emotional stimuli being presented, compared with their emotional responses at the beginning of the study. No similar verbal responses improvement or EEG-stimuli correlation was found in the control group. These results seem to indicate that music can be used to improve both emotion identification in facial expressions and emotion induction through facial stimuli in children with high-functioning ASD.

A Systematic Review of Scientific Studies on the Effects of Music in People with or at Risk for Autism Spectrum Disorder

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.

Multichannel Perception of Emotion in Speech, Voice, Facial Expression, and Gesture in Individuals With Autism: A Scoping Review

PURPOSE

Numerous studies have identified individuals with autism spectrum disorder (ASD) with deficits in unichannel emotion perception and multisensory integration. However, only limited research is available on multichannel emotion perception in ASD. The purpose of this review was to seek conceptual clarification, identify knowledge gaps, and suggest directions for future research.

METHOD

We conducted a scoping review of the literature published between 1989 and 2021, following the 2005 framework of Arksey and O'Malley. Data relating to study characteristics, task characteristics, participant information, and key findings on multichannel processing of emotion in ASD were extracted for the review.

RESULTS

Discrepancies were identified regarding multichannel emotion perception deficits, which are related to participant age, developmental level, and task demand. Findings are largely consistent regarding the facilitation and compensation of congruent multichannel emotional cues and the interference and disruption of incongruent signals. Unlike controls, ASD individuals demonstrate an overreliance on semantics rather than prosody to decode multichannel emotion.

CONCLUSIONS

The existing literature on multichannel emotion perception in ASD is limited, dispersed, and disassociated, focusing on a variety of topics with a wide range of methodologies. Further research is necessary to quantitatively examine the impact of methodological choice on performance outcomes. An integrated framework of emotion, language, and cognition is needed to examine the mutual influences between emotion and language as well as the cross-linguistic and cross-cultural differences.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19386176.

The autistic brain can process local but not global emotion regularities in facial and musical sequences

Whether autism spectrum disorder (ASD) is associated with a global processing deficit remains controversial. Global integration requires extraction of regularity across various timescales, yet little is known about how individuals with ASD process regularity at local (short timescale) versus global (long timescale) levels. To this end, we used event-related potentials to investigate whether individuals with ASD would show different neural responses to local (within trial) versus global (across trials) emotion regularities extracted from sequential facial expressions; and if so, whether this visual abnormality would generalize to the music (auditory) domain. Twenty individuals with ASD and 21 age- and IQ-matched individuals with typical development participated in this study. At an early processing stage, ASD participants exhibited preserved neural responses to violations of local emotion regularity for both faces and music. At a later stage, however, there was an absence of neural responses in ASD to violations of global emotion regularity for both faces and music. These findings suggest that the autistic brain responses to emotion regularity are modulated by the timescale of sequential stimuli, and provide insight into the neural mechanisms underlying emotional processing in ASD.

A randomised controlled feasibility trial of music-assisted language telehealth intervention for minimally verbal autistic children-the MAP study protocol

BACKGROUND

About 30% of children with autism spectrum disorder (ASD) do not develop functional speech and remain non-verbal or minimally verbal even after years of speech, language and educational interventions. A wide range of interventions have been developed for improving communication in ASD, but none have proved effective in eliciting functional language in ASD children. Research has found that people with ASD are more likely to have perfect pitch and prefer music to language. Further, it seems that language delay tends to co-occur with better musical skills. Brain imaging research has found that music alongside words increases the attention that people with ASD pay to spoken words.

METHODS

In this protocol, we describe our music-assisted programmes (MAP) that will use music to attract the attention of people with ASD to speech. MAP may open the brain pathways to language and therefore help improve communication skills for people with ASD more than standard communication protocols. In particular, we aim to develop and test whether individualised, easily used MAP would increase spoken language in 24-60-month-old, nonverbal or minimally verbal children with ASD. We will develop a structured training method, delivered through naturalistic, interactive activities (e.g. songs) to teach language to ASD children. We will test this by comparing two groups: one undertaking music-assisted programmes, and the other receiving speech and language therapy in the way that is recommended in NHS clinics. Participants will be allocated to groups randomly. The feasibility of MAP will be assessed through estimations of recruitment and retention rates, the sensitivity and reliability of the outcome measures, the intensity and frequency of the trial, the usability of the MAP app (beta version), and the burden of the assessments for the children and parents.

DISCUSSION

This feasibility randomised controlled trial will establish the acceptability and estimate the power of the MAP intervention to improve early word learning in children with ASD. In the longer term, this research will help us develop an app for parents or carers of children with ASD to design their own songs and implement their own individualised MAP.

TRIAL REGISTRATION

ISRCTN, ISRCTN12536062 . Registered on 26 June 2019.

Autism, music and Alexithymia: A musical intervention to enhance emotion recognition in adolescents with ASD

BACKGROUND

Difficulties identifying and describing emotions in Autism Spectrum Disorder (ASD) have been linked with an increased prevalence of Type 2 Alexithymia. Alexithymia is associated with difficulties in interpreting and verbally labelling physiological arousal. Children and adults with ASD show typical patterns of physiological arousal to music and can attribute verbal labels to musical emotions.

AIM

This pilot study aimed to develop a music-based intervention to improve facial and vocal emotion recognition (ER) and Alexithymia in adolescents with ASD.

METHODS AND PROCEDURES

Adolescents with ASD completed 5 music sessions and pre and post-tests of Alexithymia, ER and language. Each intervention began with a researcher-led group analysis of the emotions expressed in a series of musical excerpts, followed by a group-led discussion of the participants' experiences of these emotions and the ways they may be communicated. Finally, the likely causes and outward expression of these emotions were discussed.

OUTCOME AND RESULTS

Results showed that at pre-test, chronological age (CA) and receptive vocabulary were significantly associated with recognition of facial and verbal emotions and Not hiding emotions. At post-test, older children showed a greater increase in recognition of voices and in emotional bodily awareness. Correlations suggested a trend towards increased ER in voices and faces in children with lower language scores.

CONCLUSIONS AND IMPLICATIONS

Music-based interventions may enhance ER in adolescents with ASD and Alexithymia. Limitations and recommendations for future investigations are discussed.

Beyond Face and Voice: A Review of Alexithymia and Emotion Perception in Music, Odor, Taste, and Touch

Alexithymia is a clinically relevant personality trait characterized by deficits in recognizing and verbalizing one's emotions. It has been shown that alexithymia is related to an impaired perception of external emotional stimuli, but previous research focused on emotion perception from faces and voices. Since sensory modalities represent rather distinct input channels it is important to know whether alexithymia also affects emotion perception in other modalities and expressive domains. The objective of our review was to summarize and systematically assess the literature on the impact of alexithymia on the perception of emotional (or hedonic) stimuli in music, odor, taste, and touch. Eleven relevant studies were identified. On the basis of the reviewed research, it can be preliminary concluded that alexithymia might be associated with deficits in the perception of primarily negative but also positive emotions in music and a reduced perception of aversive taste. The data available on olfaction and touch are inconsistent or ambiguous and do not allow to draw conclusions. Future investigations would benefit from a multimethod assessment of alexithymia and control of negative affect. Multimodal research seems necessary to advance our understanding of emotion perception deficits in alexithymia and clarify the contribution of modality-specific and supramodal processing impairments.

Electroencephalographic Correlate of Mexican Spanish Emotional Speech Processing in Autism Spectrum Disorder: To a Social Story and Robot-Based Intervention

Socio-emotional impairments are key symptoms of Autism Spectrum Disorders. This work proposes to analyze the neuronal activity related to the discrimination of emotional prosodies in autistic children (aged 9 to 11-year-old) as follows. Firstly, a database for single words uttered in Mexican Spanish by males, females, and children will be created. Then, optimal acoustic features for emotion characterization will be extracted, followed of a cubic kernel function Support Vector Machine (SVM) in order to validate the speech corpus. As a result, human-specific acoustic properties of emotional voice signals will be identified. Secondly, those identified acoustic properties will be modified to synthesize the recorded human emotional voices. Thirdly, both human and synthesized utterances will be used to study the electroencephalographic correlate of affective prosody processing in typically developed and autistic children. Finally, and on the basis of the outcomes, synthesized voice-enhanced environments will be created to develop an intervention based on social-robot and Social Story^TM for autistic children to improve affective prosodies discrimination. This protocol has been registered at BioMed Central under the following number: ISRCTN18117434.

Hearing the feeling: Auditory emotion perception in Williams syndrome

BACKGROUND

Studies investigating recognition of facial expressions of emotions in Williams syndrome (WS) have reported difficulties in recognising negative expressions of emotion and a reliance on atypically developing underlying processes during task performance.

AIM

The aim of the study was to extend these findings to the recognition of emotions in auditory domains.

METHOD AND PROCEDURES

Children and adolescents with WS, together with chronological (CA) and verbal mental age matched (VMA) typically developing (TD) comparison groups, were asked to judge expressions of happiness, sadness, anger, and fear in vocal and musical conditions.

OUTCOMES AND RESULTS

Total emotion recognition scores did not differ between WS and VMA matched groups but profiles of discrimination across emotion categories were markedly different. For all groups, the accessibility of emotion category cues differed across music and speech domains. The results suggested that emotion discrimination is more strongly linked with cognitive ability in WS than in TD.

CONCLUSIONS AND IMPLICATIONS

Although WS and TD groups showed a significantly different profile of discrimination across emotion categories, similarities in the pattern of discrimination across domains and in the correlates of auditory emotion processing were observed. The results are discussed in the context of typical and atypical developmental trajectories and compensatory mechanisms in WS.

Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model

Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

PRESS-Play: Musical Engagement as a Motivating Platform for Social Interaction and Social Play in Young Children with ASD

Musical experiences are ubiquitous in early childhood. Beyond potential benefits of musical activities for young children with typical development, there has long been interest in harnessing music for therapeutic purposes for individuals with autism spectrum disorder (ASD). However, there is debate as to the effectiveness of these approaches and thus a need to identify mechanisms of change (or active ingredients) by which musical experiences may impact social development in young children with ASD. In this review, we introduce the PRESS-Play framework, which conceptualizes musical activities for young children with ASD within an applied behavior analysis framework consistent with the principles of naturalistic developmental behavioral interventions. Specifically, the PRESS-Play framework proposes that musical activities support key elements of evidence-based approaches for social engagement including predictability, reinforcement, emotion regulation, shared attention, and social play context, providing a platform for delivery and receipt of social and behavioral instruction via a transactional, developmental approach. PRESS-Play considers that these factors may impact not only the child with ASD but also their interaction partner, such as a parent or peer, creating contexts conducive for validated social engagement and interaction. These principles point to focused theories of change within a clinical-translational framework in order to experimentally test components of social-musical engagement and conduct rigorous, evidence-based intervention studies.

Music-Evoked Reward and Emotion: Relative Strengths and Response to Intervention of People With ASD

This review presents research findings showing that music is a unique domain to assess perception, reward, emotion, and associated physiological reactions and neural circuitry of people with autism spectrum disorder (ASD). There is growing evidence, reported in several studies in this review article, indicating that music is a relative strength of people with ASD including musical pitch perception, musical memory, and identification of music-evoked emotions. Listening to music activates neural circuits of reward and emotion response, which are described. Research presented shows adults with ASD also activate these systems when listening to music, although there may be developmental differences in the physiological and neural response to music in childhood and adolescence alongside typical behavioral response. Nonetheless, studies reviewed lend support to the use of music therapy and education for people with ASD, specifically to improve social skills and communication. Neural correlates of response to music therapy and education are also discussed. Taken together, findings reviewed provide evidence for music as a strength-based approach for ASD to assess reward and emotion response and as a powerful tool for intervention.

Beyond Broadway: Analysis of Qualitative Characteristics of and Individual Responses to Creatively Able, a Music and Movement Intervention for Children with Autism

Movement in response to music represents one of the natural social environments in which physical activity occurs. The study of music and movement, including dance, requires a careful, holistic consideration of many features, which may include music, physical activity, motor learning, social engagement, emotion, and creativity. The overarching goal of this manuscript is to examine qualitative characteristics of and individual responses to a music and movement intervention (Creatively Able) for children with Autism Spectrum Disorder (ASD). We provide a description of Creatively Able, illustrating how the program design and physical and social environment were informed by children's needs and preferences in order to provide an enriched environment in which to promote multiple systems in children with ASD. Using data from two pilot studies with 20 children with ASD, we illustrate how researchers can use observational research methods to measure important aspects of the social environment (e.g., children's engagement during intervention sessions) as well as engagement of potential underlying behavioral mechanisms (e.g., self-regulation) that might reduce clinical symptoms. We further illustrate how individual responses to intervention (e.g., improvements in behaviors or symptoms) can be studied in physically active interventions. Our pilot study results showed group-level reductions in Stereotyped and Compulsive behaviors of 8% and 4%, respectively; posthoc analysis revealed that there were substantial individual differences in children's responses to the intervention. This research illustrates robust methods that can be applied to intervention research to improve our understanding of important features of interventions that might help promote development in various domains, including executive functions and self-regulation.

The potential role of rhythmic entrainment and music therapy intervention for individuals with autism spectrum disorders

Autism spectrum disorder (ASD) is characterized by social and interpersonal communication disabilities and repetitive motor activities. A deficit in social interaction may be due to motor and synchronization disabilities in individuals with ASD. These disabilities serve as a hindrance for the progression of day-to-day life. ASD individuals are known to have variations in the neural network contributing to changes in their oral-motor activity. As the brain has experience-dependent structural plasticity, these changes in the neural network can probably be reversed with appropriate treatment Music playing a universal role in human life has been studied for its therapeutic potential in rehabilitation of ASD individuals. Music and rhythm have shown a significant potential in improving the oral-motor activities of people affected by ASD. Music based interventions are being used for children diagnosed with ASDs to improve their social communication and motor skills. This article represents the possible role of rhythmic cueing for sensorimotor regulation in ASD individuals. This can serve as a base for further research for the impact of musical therapy on coordination and oral-motor synchronization of individuals diagnosed with ASD.

Insular function in autism: Update and future directions in neuroimaging and interventions

The insular cortex, hidden within the lateral sulcus of the human brain, participates in a range of cognitive, affective, and sensory functions. Autism spectrum disorder (ASD), a neurodevelopmental condition affecting all of these functional domains, has increasingly been linked with atypical activation and connectivity of the insular cortices. Here we review the latest research linking atypical insular function to a range of behaviors characteristic of ASD, with an emphasis on neuroimaging findings in the domains of social cognition and executive function. We summarize some of the recent work linking the insula to interventions in autism, including oxytocin-based pharmacological treatments and music therapy. We suggest that future directions likely to yield significant insights into insular pathology in ASD include the analysis of the dynamics of this brain region. We also conclude that more basic research is necessary on the use of oxytocin pharmacotherapy, and larger studies addressing participant heterogeneity are needed on the use of music therapy in ASD. Long-term studies are needed to ascertain sustained effects of these interventions.

Musical disability in children with autism spectrum disorder

Although enhanced musical ability is reported in individuals with autism spectrum disorders (ASD), this observation may be uncommon, and reports of auditory processing deficits suggest musical ability may be impaired. We hypothesized that musical ability would be impaired in children with ASD, that the severity of impairment would correlate with cognitive dysfunction, and with clinical features of illness. We evaluated 26 children with ASD and 27 typically developing (TD) children using the Montreal Battery of Evaluation of Amusia short version (MBEA-s) as well as cognitive tests and clinical evaluations of ASD symptomatology. Mean scores on the MBEA-s were significantly lower in children with ASD. MBEA-s scores did not correlate with cognitive test results in either ASD or TD children, and did not correlate with symptom severity in ASD children. For the ASD children only, the combination of hyperactivity/inattention and working memory resulted in a significant contribution to the variance in the MBEA-s score. The findings indicate that musical ability appears to be impaired in children with ASD, and assessment of musical ability may complement cognitive tests and measures of symptomatology in characterizing the shared neural substrates for these dysfunctions in ASD.

Alexithymia and Autism Spectrum Disorder: A Complex Relationship

Alexithymia is a personality construct characterized by altered emotional awareness which has been gaining diagnostic prevalence in a range of neuropsychiatric disorders, with notably high rates of overlap with autism spectrum disorder (ASD). However, the nature of its role in ASD symptomatology remains elusive. Here, we distill research at the intersection of alexithymia and ASD. After a brief synopsis of the studies that plaid a pioneering role in the identification of the overlapping fields between alexithymia and ASD, we comb the literature for evidence of its overlap with ASD in terms of prevalence, etiology, and behaviors. Through a formalized framework of the process of emotional interpretation and expression, we explore evidence for where and how deficits arise in this complex network of events. We portray how these relate to the dynamic interplay between alexithymic and autistic traits and find emerging evidence that alexithymia is both a cause and consequence of autistic behaviors. We end with a strategic proposal for future research and interventions to dampen the impacts of alexithymia in ASD.

Anhedonia to music and mu-opioids: Evidence from the administration of naltrexone

Music’s universality and its ability to deeply affect emotions suggest an evolutionary origin. Previous investigators have found that naltrexone (NTX), a μ-opioid antagonist, may induce reversible anhedonia, attenuating both positive and negative emotions. The neurochemical basis of musical experience is not well-understood, and the NTX-induced anhedonia hypothesis has not been tested with music. Accordingly, we administered NTX or placebo on two different days in a double-blind crossover study, and assessed participants’ responses to music using both psychophysiological (objective) and behavioral (subjective) measures. We found that both positive and negative emotions were attenuated. We conclude that endogenous opioids are critical to experiencing both positive and negative emotions in music, and that music uses the same reward pathways as food, drug and sexual pleasure. Our findings add to the growing body of evidence for the evolutionary biological substrates of music.

Social functioning and autonomic nervous system sensitivity across vocal and musical emotion in Williams syndrome and autism spectrum disorder

Both Williams syndrome (WS) and autism spectrum disorders (ASD) are associated with unusual auditory phenotypes with respect to processing vocal and musical stimuli, which may be shaped by the atypical social profiles that characterize the syndromes. Autonomic nervous system (ANS) reactivity to vocal and musical emotional stimuli was examined in 12 children with WS, 17 children with ASD, and 20 typically developing (TD) children, and related to their level of social functioning. The results of this small-scale study showed that after controlling for between-group differences in cognitive ability, all groups showed similar emotion identification performance across conditions. Additionally, in ASD, lower autonomic reactivity to human voice, and in TD, to musical emotion, was related to more normal social functioning. Compared to TD, both clinical groups showed increased arousal to vocalizations. A further result highlighted uniquely increased arousal to music in WS, contrasted with a decrease in arousal in ASD and TD. The ASD and WS groups exhibited arousal patterns suggestive of diminished habituation to the auditory stimuli. The results are discussed in the context of the clinical presentation of WS and ASD.

Intact brain processing of musical emotions in autism spectrum disorder, but more cognitive load and arousal in happy vs. sad music

Music is a potent source for eliciting emotions, but not everybody experience emotions in the same way. Individuals with autism spectrum disorder (ASD) show difficulties with social and emotional cognition. Impairments in emotion recognition are widely studied in ASD, and have been associated with atypical brain activation in response to emotional expressions in faces and speech. Whether these impairments and atypical brain responses generalize to other domains, such as emotional processing of music, is less clear. Using functional magnetic resonance imaging, we investigated neural correlates of emotion recognition in music in high-functioning adults with ASD and neurotypical adults. Both groups engaged similar neural networks during processing of emotional music, and individuals with ASD rated emotional music comparable to the group of neurotypical individuals. However, in the ASD group, increased activity in response to happy compared to sad music was observed in dorsolateral prefrontal regions and in the rolandic operculum/insula, and we propose that this reflects increased cognitive processing and physiological arousal in response to emotional musical stimuli in this group.

Brain correlates of music-evoked emotions

Music is a universal feature of human societies, partly owing to its power to evoke strong emotions and influence moods. During the past decade, the investigation of the neural correlates of music-evoked emotions has been invaluable for the understanding of human emotion. Functional neuroimaging studies on music and emotion show that music can modulate activity in brain structures that are known to be crucially involved in emotion, such as the amygdala, nucleus accumbens, hypothalamus, hippocampus, insula, cingulate cortex and orbitofrontal cortex. The potential of music to modulate activity in these structures has important implications for the use of music in the treatment of psychiatric and neurological disorders.

The neurochemistry of music

Music is used to regulate mood and arousal in everyday life and to promote physical and psychological health and well-being in clinical settings. However, scientific inquiry into the neurochemical effects of music is still in its infancy. In this review, we evaluate the evidence that music improves health and well-being through the engagement of neurochemical systems for (i) reward, motivation, and pleasure; (ii) stress and arousal; (iii) immunity; and (iv) social affiliation. We discuss the limitations of these studies and outline novel approaches for integration of conceptual and technological advances from the fields of music cognition and social neuroscience into studies of the neurochemistry of music.

The effects of autism and alexithymia on physiological and verbal responsiveness to music

It has been suggested that individuals with autism will be less responsive to the emotional content of music than typical individuals. With the aim of testing this hypothesis, a group of high-functioning adults on the autism spectrum was compared with a group of matched controls on two measures of emotional responsiveness to music, comprising physiological and verbal measures. Impairment in participants ability to verbalize their emotions (type-II alexithymia) was also assessed. The groups did not differ significantly on physiological responsiveness, but the autism group was significantly lower on the verbal measure. However, inclusion of the alexithymia score as a mediator variable nullified this group difference, suggesting that the difference was due not to absence of underlying emotional responsiveness to music in autism, but to a reduced ability to articulate it.

Are emotion impairments unique to, universal, or specific in autism spectrum disorder? A comprehensive review

There is widespread belief that individuals with autism spectrum disorders (ASDs) are "emotionally detached" from others. This comprehensive review examines the empirical evidence for this assumption, addressing three critical questions: (1) Are emotion-processing impairments universal in ASD? (2) Are they specific, or can they be explained by deficits in other domains? (3) Is the emotion processing profile seen in ASD unique to these conditions? Upon review of the literature (over 200 studies), we conclude that: (1) emotion-processing impairments might not be universal in ASD, as suggested by variability across participants and across emotion-processing tasks; (2) emotion-processing impairments might not be specific to ASD, as domain-general processes appear to account for some of these impairments; and (3) the specific pattern of emotion-processing strengths and weaknesses observed in ASD, involving difficulties with processing social versus non-social, and complex versus simple emotional information (with impairments more consistently reported on implicit than explicit emotion-processing tasks), appears to be unique to ASD. The emotion-processing profile observed in ASD might be best understood as resulting from heterogeneous vulnerabilities in different components of an "emotional communication system" that, in typical development, emerges from the interplay between domain-general cognitive, social and affective processes.

Musicality Correlates With Sociability and Emotionality in Williams Syndrome

Williams Syndrome (WS) is a neurogenetic developmental disorder characterized by peaks and valleys of cognitive abilities. One peak that has been understudied is the affinity that many individuals with WS have toward music. It remains unknown whether their high levels of musical interest, skill and expressivity are related to their sociable personality or their verbal intelligence. We examined the relationships between musicality (musical interest, creativity and expressivity), sociability (social-emotionality, social approach) and language comprehension in WS and typically developing (TD) controls. Findings suggest that emotion-expressivity through music in WS may be linked to their sensitivity and responsivity to emotions of others, whereas general interest in music may be related to greater linguistic capacity in TD individuals. Musicality and sociability may be more closely related in WS relative than in typical development; implications for future interventions for this neurodevelopmental condition will be discussed.

Processing of musical structure by high-functioning adolescents with autism spectrum disorders

Enhanced pitch perception and memory have been cited as evidence of a local processing bias in autism spectrum disorders (ASD). This bias is argued to account for enhanced perceptual functioning ( Mottron & Burack, 2001 ; Mottron, Dawson, Soulières, Hubert, & Burack, 2006 ) and central coherence theories of ASD ( Frith, 1989 ; Happé & Frith, 2006 ). A local processing bias confers a different cognitive style to individuals with ASD ( Happé, 1999 ), which accounts in part for their good visuospatial and visuoconstructive skills. Here, we present analogues in the auditory domain, audiotemporal or audioconstructive processing, which we assess using a novel experimental task: a musical puzzle. This task evaluates the ability of individuals with ASD to process temporal sequences of musical events as well as various elements of musical structure and thus indexes their ability to employ a global processing style. Musical structures created and replicated by children and adolescents with ASD (10-19 years old) and typically developing children and adolescents (7-17 years old) were found to be similar in global coherence. Presenting a musical template for reference increased accuracy equally for both groups, with performance associated to performance IQ and short-term auditory memory. The overall pattern of performance was similar for both groups; some puzzles were easier than others and this was the case for both groups. Task performance was further found to be correlated with the ability to perceive musical emotions, more so for typically developing participants. Findings are discussed in light of the empathizing-systemizing theory of ASD ( Baron-Cohen, 2009 ) and the importance of describing the strengths of individuals with ASD ( Happé, 1999 ; Heaton, 2009 ).

Do Apparent Overlaps between Schizophrenia and Autistic Spectrum Disorders Reflect Superficial Similarities or Etiological Commonalities?

STUDY BACKGROUND: Schizophrenia and autism are both neurodevelopmental disorders that were once considered to be the same disorder expressed in different developmental periods. Although they were separated diagnostically about 40 years ago, they share several clinical and possibly, etiological features. This paper reviews overlaps in four domains of function to consider the issue of whether these similarities are sporadic and likely to represent superficial similarities, or whether the disorders are more likely to share some features in common. METHODS: Representative areas of function were reviewed and compared for aspects of cognition (nonverbal reasoning, memory and language), social function (orienting/joint attention, eye contact and theory of mind), brain function (structural differences) and genetics. To facilitate comparisons with schizophrenia, a focus on high functioning autism/Asperger's disorder was utilized, particularly in the sections on cognition and social function. RESULTS: Significant similarities (and differences) characterized comparisons in each domain. CONCLUSIONS: Disturbed function in similar clinical (in cognition and social function), neurobiological (brain volumes) and genetic (e.g., involvement of the same genes or chromosomal locations) domains in autism and schizophrenia supports the hypothesis that while they are distinct disorders, they are not entirely unique. Additional studies of similarities and differences between them may thus shed light on common etiological mechanisms and hopefully, facilitate the development of novel treatment targets.