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Study protocol of a randomized control trial on the effectiveness of improvisational music therapy for autistic children

BACKGROUND

Music therapy is the clinical use of musical interventions to improve mental and physical health across multiple domains, including social communication. Autistic children, who have difficulties in social communication and often increased anxiety, tend to show a strong preference for music, because it can be structured and systematic, and therefore more predictable than social interaction. This makes music therapy a promising medium for therapeutic support and intervention. Previous clinical trials of music therapy compared to traditional therapy for autistic children have shown encouraging but nevertheless mixed results.

KEY AIMS

The primary aim is to conduct a randomised controlled trial (RCT) of improvisational music therapy for autistic children and test its effectiveness in at improving social communication and wellbeing, and to reduce anxiety.

RESEARCH PLAN

The RCT will be conducted with 200 autistic children in the UK aged 7 to 11 years old. Participants will be randomly assigned to either improvisational music therapy or support as usual. The trial will be an assessor-blind, pragmatic two-arm cluster RCT comparing the impact of 12-weeks of improvisational music therapy in addition to support as usual, vs. support as usual for autistic children.

METHODS

Researchers who are blind to which arm the children are in will conduct assessments and obtain data via caregiver reports. The primary outcome will be the absolute change in the total score of the Brief Observation of Social Communication Change (BOSCC) assessed at baseline, T1 (13 weeks) and T2 (39 weeks) follow-ups. The BOSCC consists of specific items that were developed to identify changes in social-communication behaviours. Secondary outcome measures include: (1) Parent reported anxiety scale for youth with ASD (Note that we do not use the term 'ASD' or Autism Spectrum Disorder, because many autistic people feel it is stigmatising. Instead, we use the term 'autism') (PRAS-ASD) (2) Young Child Outcome Rating Scale, for wellbeing (YCORS), (3) Strengths and Difficulties Questionnaire (SDQ); and (4) Vineland Adaptive Behaviour Scale (VABS). (5) The Children's Communication Checklist-2 (CCC-2) will be completed to evaluate pragmatic speech with fluent speakers only; (6) The Music Engagement Scale (MES); and (7) Assessment of the Quality of Relationship (AQR) will be used to evaluate the child-therapist relationships using video-analysis of music therapy sessions. Additional data will be collected by administering the Wechsler Abbreviated Scale of Intelligence (WASI-II), Music at Home Questionnaire (M@H), and children's versions of the Empathy Quotient (EQ) and Systemizing Quotient (SQ). Audio and video data from the therapy sessions will be collected and analysed (using both human and computer-based feature-coding, e.g., machine learning and AI-driven methods) to identify how music and non-musical interactions foster change throughout the therapy.

DISCUSSION

This study aims to observe if the interactions, engagement, and therapeutic modalities fostered during music therapy sessions can translate to non-musical contexts and improve autistic children's social communication skills, identifying possible mediating factors contributing to the effectiveness of music therapy, potentially informing policy making and governance.

TRIAL REGISTRATION

This randomised control trial is registered with the NIH U.S. National Library of Medicine:  https://clinicaltrials.gov/search?term=NCT06016621 , clinicalTrials.gov Identifier: NCT0601662, Registration Date 19th August 2023.

Convergent Validity for the Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders

A significant percentage of music therapists actively provides services to children with autism spectrum disorder (ASD). There is an absence, however, of a widely accepted clinical instrument, specific to music therapy work with this population, that demonstrates psychometric validation. Establishing commonality in assessing and documenting this particular work within the field would be pivotal to furthering the efforts which have established music therapy as evidenced-based practice. A study was conducted to explore the convergent validity between the Musical Emotion Assessment Rating Scale (MEARS), which is Scale I of the Individual Music-Centered Assessment Profile of the Neurodevelopmental Disorders (IMCAP-ND) assessment tool, with the Social Affect Scale domains and item variables of the Autism Diagnostic Observation Schedule (ADOS). The data revealed statistical significance, thus supporting convergent validity with several specific MEARS scores when compared with the ADOS Social Affect domain score. The current investigation supports the IMCAP-ND’s soundness as an assessment tool possessing valid and reliable psychometric properties. The convergent validity between MEARS and ADOS showed positive results in the area of social affect. Implications of this study are related to clinical practice and may impact how music therapists assess children with autism. Furthermore, this study contributes to the growing body of music therapy assessments that have yielded valid and reliable scores used to evaluate core features of ASD (e.g., social affect).

Attunement in Music Therapy for Young Children with Autism: Revisiting Qualities of Relationship as Mechanisms of Change

This study examined whether musical and emotional attunement predicts changes in improvisational music therapy with children with autism (4–7 years, N = 101, majority: no/limited speech, low IQ), assessed over 12 months. Attunement, as observed from session videos, and changes in generalized social skills, judged by blinded assessors and parents, were evaluated using standardized tools (Assessment of the Quality of Relationship, Improvisational Music Therapy Principles, ADOS, SRS). In contrast to the smaller pilot, we did not find significant effects between attunement and changes in outcomes, only tendencies in the same direction are observed. Findings suggest that symptom severity is associated with the therapist’s ability to attune to the child. They further raise questions concerning outcome selection and user involvement.