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Music therapy has little added benefit for autism

Improvisational music therapy was not significantly superior to enhanced standard care for children with autism spectrum disorders.

“A variety of approaches to improve the core deficits and lives of people with [autism spectrum disorders (ASD)] have been developed, including behavioral, developmental, educational and medical interventions, but the strength of evidence for reducing autism severity is low for most interventions,” Łucja Bieleninik, PhD, of the Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway, and colleagues wrote. “Randomized trials have suggested positive effects of music therapy on social interaction, joint attention, and parent-child relationships. Evidence on longer-term effects and dose-effect relations is lacking, and evidence that effects observed within therapy sessions generalize to other settings, situations, and people needs confirmation.”

To assess efficacy of improvisational music therapy for generalized social communication skills in ASD, researchers conducted an assessor-blinded, randomized clinical trial among children aged 4 to 7 years with ASD across nine countries. Study participants were randomly assigned to receive enhanced standard care (n = 182) or enhanced standard care plus improvisational music therapy (n = 182). Enhanced standard care consisted of usual care plus parent counseling to discuss concerns and provide information about ASD. Music therapy consisted of trained music therapists singing or playing music with each child, individualized to the child’s focus of attention.

Over 5 months, participants who received music therapy completed a median of 19 music therapy, three parent counseling, and 36 other therapy sessions, compared with three parent counseling and 45 other therapy sessions among those who received standard care.

From baseline to 5 months, mean Autism Diagnostic Observation Schedule (ADOS) social affect scores decreased from 14.08 to 13.23 among participants who received music therapy, compared with 13.49 to 12.58 among those who received standard care (mean difference = 0.06; 95% CI, –0.7 to 0.81; P = .88).

Seventeen of the 20 secondary outcomes did not significantly differ between treatment groups.

“The contradictory results between the [randomized clinical trial] by Bieleninik et al and the Cochrane review by Geretsegger et al highlight an important debate concerning the differential merits of a large [randomized clinical trial] and a comprehensive meta-analysis. These two types of studies are generally considered the most rigorous forms of clinical evidence; when they produce inconsistent findings, exploring the basis for this inconsistency is important,” Sarabeth Broder-Fingert, MD, MPH, of Boston University School of Medicine, and colleagues wrote in an accompanying editorial. “So, where does the field go from here? Is it time to abandon music therapy for ASD, or is it worth the investment to conduct further studies in more controlled settings, with carefully chosen populations, and more patient- and family-centered outcomes? This is the question now facing the ASD research and patient communities.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.