Running Head: EFFECTS OF MUSIC THERAPY ON AUTISM 1

The Effects of Music and Non-Music Therapy on Children with Autism

Augusta Fronzaglio, Emily Medlin, Kayla Boyer, Chris Maronen

04-03-2017

NURS 3749: Nursing Research

Dr. Patricia Hoyson and Mrs. Nicole Kent-Strollo

Abstract
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Title: Effects of music therapy on Autism
In this paper, articles were reviewed and discussed to determine how children with

autism are affected by music therapy on overall behavior compared with autistic children

who did not receive music therapy. Each article was broken down into social, communica-

tion, and emotional effects. Different methods were used to conduct each study and deter-

mine whether music therapy can improve behavioral skills. After reviewing several articles

and experiments, it was determined that music therapy does improve behavioral skills of

children with autism. Music therapy helps children with autism grow and develop.
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Title: Effects of music therapy on Autism
Children with autism are developmentally affected in many ways. Some cases of au-

tism are more severe than others. Communication, social, and emotional issues are com-

mon challenges among many autistic patients. For example, some children with autism may

have limited speech, difficulty with expression, limited attention spans, and disruptive be-

haviors. Music therapy is believed to be a non-pharmacologic treatment that may lessen

the symptoms or challenges that autistic children face. Music offers a familiar medium that

can help the patient engage or interact with the use of words, sounds, and interactive play.

There are multiple methods of implementing music therapy.

Literature Review

Introduction

To address this research question, information was acquired via Google Scholar and

Maag Library. Eight articles were reviewed for comprehensive data collection regarding

ways music therapy can have positive effects on children with autism. The effects reviewed

and discussed were communication, social and, emotional.

Communication

Two known forms of music therapy are RMT and MBCT. RMT stands for Relational

Music Therapy. Simply put, RMT is a non-structured method of the use of musical instru-

ments to encourage activity and communication of patients. While someone is conducting

RMT, musical instruments are placed on a surface so that the participant(s) have the ability

to choose which one they would like to use. Based on the participant’s degree of interac-

tion, the therapist may encourage him or her to participate with the instrument. The focal

point of RMT is to observe the actions of the patient. Actions that should be observed and
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Title: Effects of music therapy on Autism
encouraged are singing, composing, improvising, and playing musical games. The aim of us-

ing RMT is to hopefully build developmental capacities such as emotional, cognitive, social,

motor, and communicative skills.

In 2011, a Brazilian study was conducted testing the effects of RMT on autistic boys.

This particular study used a sample of 24 autistic boys ranging from age 7 to 12 years old.

They were recruited from the Programme for Invasive Developmental Disorders of the

Hospital de Clinical de Porto Alegre. In order to be eligible, the boys could not have re-

ceived music therapy in the past and they couldn’t have intolerance to sounds/profound

hearing loss. Each child was evaluated using the Childhood Autism Rating Scale to confirm

the presence of a diagnosis from the autistic spectrum. After all participants were con-

firmed to have either autistic disorder, pervasive developmental disorder not otherwise

specified, or Asperger’s syndrome, they were randomly divided into two groups of 12. The

experimental group participated in three music therapy sessions, sixteen weekly sessions

of Relational Music Therapy, and one final music therapy assessment session in addition to

weekly clinical routine activities. Each session was 30 minutes long. The control group par-

ticipated in only weekly clinical routine activities. Results of the therapy were measured

using the CARS-BR scale. This scale is used to measure and assess the presence, degree, and

specific behaviors of autism in an individual. The aspects assessed in this study were ver-

bal, nonverbal, and social communication. The CARS-BR scale was used before and after

music therapy was implemented. After evaluating all scores and results, the use of RMT

was only favored when comparing the results of nonverbal communication between the ex-

perimental and control group. The data was deemed statistically insignificant. The small
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Title: Effects of music therapy on Autism
sample size and use of CARS-BR scale may be to blame for the insignificance. (Gattino, G. S.,

Riesgo, R. S., Longo, D., Leite, J. L., & Faccini, L. S., 2011)

Another known method is MBCT or Melodic-Based Communication Therapy. This

method is unlike RMT because it lacks improvisation. MBCT is the use of preprogrammed

or prerecorded melodies on CD’s to evoke certain words while using rhythm. A common

source of rhythm that the child can get involved with is clapping. Another way this method

differs from RMT is that it doesn’t require musical instruments and it can be practiced al-

most anywhere opposed to RMT being confined to a musical or clinical setting.

In 2013, a pilot study was performed to assess the effects of Melodic-Based Commu-

nication therapy on autistic patients. In this particular study, twelve autistic children aged

5 to 7 participated. The examiner chose 25 words that were known to be most of the first

words that children typically learn. Each word was paired with a melody. The tool used for

examining the outcomes was the ADOS or Autism Diagnostic Observation Schedule. This

particular tool focuses on communication, social interaction, and play. More specifically,

the outcomes measured were the number of verbal attempts, the number of correct words,

and the number of words reported by the parents. The goal of this study was to have all 25

of the words learned by a specific time frame. The children participated in multiple 45 mi-

nute sessions per week for five weeks. When results from the experimental group were

compared to the control group, the experimental group learned more words than the con-

trol group in a shorter amount of time with the use of MBCT. (Vries, D. D., Beck, T., Stacey,

B., Winslow, K., & Meines, K., 2015)

Social
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Title: Effects of music therapy on Autism
Finnigan and Starr (2010) performed a study on a preschool child with autism, using mu-

sic and non-music interventions to compare social and avoidant behavior responses. The study

involved 29 sessions over the course of 2 months. The child participated in four 15-minute ses-

sions each week (Finnigan & Starr, 2010). Two of the sessions were completed in a home set-

ting and the remaining two were completed in an isolated preschool classroom. During each ses-

sion, the music therapist, participant, and either the mother or the child’s behavior therapist

would sit behind the child. The mother or behavior therapist sitting behind the child would redi-

rect as needed, but never prompted the child to complete a task in any way. Six toys, chose at

random, were used during the intervention as controlled objects. The toys chosen for the music

intervention were a large ball, a plastic car with two plastic people, and a large gathering drum

(Finnigan & Starr, 2010). During the non-music intervention the toys picked were five plastic

farm animals, colorful stacking cups, and two plastic maracas (Finnigan & Starr, 2010).

Throughout the music intervention sessions, the therapist used a guitar and would sing familiar

melodies using music lyrics that applied to the toy that was being played with. The opposite was

done in the non-music intervention. Instead of singing the lyrical melodies, the therapist would

speak the lyrics.

The study had four phases including baseline, alternating treatments, second treatment,

and follow-up. The baseline phase started with the child sitting on the floor, given one of the six

toys randomly every 3 minutes (Finnigan & Starr, 2010). The therapist did not use music, in-

struction, or prompting but offered opportunities for imitation and turn taking by tapping the ball

or shaking the maraca up high (Finnigan & Starr, 2010). Finnigan and Starr (2010) found that at

the end of 8 sessions there was a stable baseline of social responses and avoidant behaviors so,
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Title: Effects of music therapy on Autism
they proceeded to Phase B. Phase B or the alternating phase used both music and non-music in-

terventions randomly over the course of 12 sessions. During the music intervention, the therapist

used the drum, car, and the ball. Each one was given to the child for 5 minutes. During this phase

the therapist sang simple melodies along with a guitar and gave the child opportunities to engage

in social responses such as eye contact, imitating, or taking turns (Finnigan & Starr, 2010). Dur-

ing the non-music intervention the stacking cups, farm animals, and maracas were used and

given to the child one at a time for 5 minutes. The same opportunities for engaging in a social re-

sponse were present in the non-music intervention, but no usage of music or the guitar occurred

as opposed to the music intervention. The phase continued until there was a change in behavior

such as the number of social responses and avoidant behaviors increasing and decreasing until

the 12 sessions were completed (Finnigan & Starr, 2010).

Phase C, the second treatment phase, was done over 7 sessions and the toys used were

ones considered to be less effective in Phase B. Phase C is meant to compare the toys used in the

less effective intervention with the toys in the more effective intervention (Finnigan & Starr,

2010). The same method of giving a toy for x amount of minutes and giving opportunities for

the child to observe, as well as, display social responses and avoidant behaviors were used in this

phase. The follow up phase, being the last stage was done one week apart, beginning two weeks

after the final intervention phase completion (Finnigan & Starr, 2010). The follow up phase was

similar to the baseline phase where the child was given six toys randomly for 3 minutes with no

instruction from the therapist. This was done to interpret if the social behaviors from the child

had been sustained during the intervention phases (Finnigan & Starr, 2010).
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Title: Effects of music therapy on Autism
Eye contact was not made with the music therapist during the baseline phase. During the

alternate treatment, Phase B, eye contact did not occur during the non-music intervention ses-

sion. During the music intervention, 5 out of 6 session’s eye contact was observed ranging from

1 to 3 occurrences for a mean of 1.5 (Finnigan & Starr, 2010). The music intervention was indi-

cated to be a more effective way, so it could be used in Phase C. For Phase C the less effective,

non-music toys were used and when they were used with music, eye contact was observed 6 out

of 7 sessions having the range from 3 to 5 occurrences with a mean of 3.4 (Finnigan & Starr,

2010). However, during the follow up stage when no music was used the occurrence of eye con-

tact had returned back to zero (Finnigan & Starr, 2010). Imitation skills in the baseline phase

were not observed. When non-music intervention techniques were used in Phase B, imitation had

a low percentage of 37.2% (Finnigan & Starr, 2010). However, when phase B occurred with mu-

sic, the imitation skills improved and the percentage of that skill moved up to 83% (Finnigan &

Starr, 2010).

Phase C used the toys from the non-music intervention in Phase B. When the same toys

were used in Phase C while implementing the music intervention, there was a high imitation per-

centage of 68.1% (Finnigan & Starr, 2010). During the follow up stage, where no music was

used, there was a decrease in imitation for the child. This can conclude that Phase C, music inter-

vention, was successful in increasing imitation skills. Turn taking with the music and non-music

intervention concluded that using the music intervention successfully increased the child’s turn-

taking skills (Finnigan & Starr, 2010).

Pushing away toys during the baseline phase only occurred with two toys, the ball and

maracas. During phase B, the alternating phase, the child did not push the toys away during the

music intervention but during the non-music intervention she pushed away the maracas once
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Title: Effects of music therapy on Autism
(Finnigan & Starr, 2010). During the final two phases, C and the follow up, the child did not

push away any of the toys. Moving away during the baseline phase occurred 3 times; twice

when the ball was presented and once when the maracas were presented (Finnigan & Starr,

2010). During Phase B the child did not move away during the music intervention, but during

the non-music intervention she moved away 4 times when maracas were presented and once dur-

ing the stacking cups activity (Finnigan & Starr, 2010). During phase C and the follow up phase,

no moving away behaviors were exhibited (Finnigan & Starr, 2010).

After this study was completed, it showed that the music condition was effective in increasing

social response behaviors and decreasing avoidant behaviors compared to the non-music inter-

vention (Finnigan & Starr, 2010).

LaGasse designed a study to assess the use of music therapy with autistic children to de-

termine if their social skills would increase. The study was created to observe the music interven-

tion on eye gaze, joint attention, and communication in children with autism spectrum disorder

(LaGasse, 2014). The study contained seventeen children ages 6 to 9, randomly assigned to ei-

ther a music therapy group or non-music therapy group (LaGasse, 2014). The goal was to assess

social skills of the children who participated in ten 50-minute group sessions over a time of 5-

week period (LaGasse, 2014).

The difference between the music therapy group and non-music therapy group was the

joint attention with other people and eye gaze towards people were much higher in the music

therapy group. There was no difference, however, in responses to communication or social with-

drawal behaviors in the music therapy group and the non-music group (LaGasse, 2014).

Emotional
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Title: Effects of music therapy on Autism
The first method used started with a search approach. Literature reviews were con-

ducted using several different databases. In the databases, key words were used to get bet-

ter search results. Sin, Lin and Xie used the following key words to find their articles: “au-

tistic children,” “children with autism,” “music therapy,” and “music treatment.” The year

range for these articles were August 2000 to August 2005. This study included all research

articles relating to randomized controlled trials using music therapy on autistic children.

The focus was 228 boys and 72 girls aged 2-7 years old. Three studies were performed as-

sessing emotions and mood of 108 individuals. In this study, the experimental group re-

ceived music therapy while the controlled group got non-music therapy. The music therapy

methods used in this study were listening to music, singing, playing a musical instrument,

performing music, and music storytelling. Before beginning the trial, children were as-

sessed. Different scales and checklists were used to observe mood, language, behavior, sen-

sory perception, and social skills. Doing this placed each subject at a baseline.

Sin, Lin, and Xie's studies examined the effect of music therapy on the mood of chil-

dren with autism. Three studies of 108 individuals were observed. There were 54 in the ex-

perimental group and 54 in the control group. The meta-analysis used to evaluate the data

from the three studies showed that two groups displayed a substantial difference in the

mood scores of the children after treatment. These outcomes showed that music interven-

tion enhanced the mood in autistic children. Additionally, music therapy can be used to re-

construct, preserve, and encourage mental and physical health which increases the mood in

children with autism.

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Title: Effects of music therapy on Autism
Another method used two different search strategies. All relevant randomized con-

trolled trials and controlled clinical trials were reviewed. Articles were excluded if individ-

uals received treatment in a sequence order. Individuals with autism spectrum disorder

aged 2-9 years old and mostly boys were included. Interventions included music therapy

that was delivered by a professional musical therapist, placebo therapy, or no treatment.

Ten studies were conducted using 165 individuals total. Six studies used small groups

ranging from four to ten people. Four studies used a large group ranging from 22-24 and

one group of 50 (Lim 2010.) Trials lasted for a short period or a medium period of time.

The time range was one week to eight months. Trials were conducted at homes, schools,

hospitals, and outpatient units. Both methods investigated how music therapy affects the

emotions of an autistic child.

Geretsegger, Elefant, Mossler, and Gold’s study involved ten different studies rang-

ing from one week to eight months. In the ten studies a total of 165 children with autism

ranging from 2-9 years old were studied. They studied the short and medium-term effect of

music therapy. After all the studies were completed, they concluded that children receiving

music therapy had higher scores on an emotional scale than those that received the placebo

therapy. Not only does it help with their emotions, but also their emotional skill expansion.

Communication, Social, and Emotional

Different methods were used when looking at certain studies and articles that have

been written about music therapy on autistic children. However, before researching arti-

cles, criteria of what types of studies that will be included needed to be established. For one

of our articles, Keen and Simpson had 4 criteria. The articles had to be published in a peer

reviewed journal and had to have an experimental control. The participants in the study
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Title: Effects of music therapy on Autism
had to be 0-18 years old with autism and could not have any savant behavior in the area of

music (Keen and Simpson 2011). The sample of their study was 106 children 0 -18 years

old, but mainly focused on 3-11 years old. 2 of the 106 children were 12-18 years old.

There are plenty of different ways to measure music therapy, but Keen and Simpson mainly

measured composed songs and improvisational music therapy.

Keen and Simpson found that “a number of study characteristics emerged that may

potentially impact on the effectiveness of music interventions” (Keen and Simpson 2011).

Keen and Simpson found that by using music therapy, nonmusical and musical behaviors

were increased (Keen and Simpson 2011). This study measured its results by having the

participant’s teachers, parents, and therapist fill out a survey based on behavior change.

This study was a 10-week long study. In one of the studies that Keen and Simpson reviewed

showed children responded better to music therapy when compared with play therapy.

This study showed that music therapy improved joint attention, eye contact, and turn tak-

ing. During this study, children even had higher emotional synchronicity, joy, and initiation

of engagement and for longer periods of time then when compared with the play session.

Another method used when determining the effectiveness of music therapy on au-

tism is comparing the children’s emotional and interpersonal response during a play ses-

sion and improvisational music therapy. Kim, Gold, and Wigram researched 15 children, ag-

ing 3-5 years old, by comparing each child during a play session and improvisational music

therapy session of the same duration consisting of weekly 30 minute sessions for 12 weeks

each condition. They compared music therapy versus play therapy. During those sessions,

they measured the frequency and duration of joy, emotional synchronicity, initiation of en-

gagement, and the frequency of compliance and no response.

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Title: Effects of music therapy on Autism
In the Kim, Gold, and Wigram study, they found that “music therapy promotes social,

emotional, and motivational development in children with autism” (Kim, Gold, Wigram

2009). This study showed that initiation of engagement of play was increased and eventu-

ally got more frequent throughout this study. With any study, compliance is important.

However with this study it’s essential because when measured, it showed that music ther-

apy did in fact have a positive effect on children with autism. In the Kim, Gold, and Wigram

study, they found that compared to a play session, music therapy had an impact on joy and

emotional synchronicity. They even discovered that when the children were in control,

they were more likely to respond than when the therapist was in control.

Conclusion

After reviewing articles and studies conducted on music therapy as treatment to im-

prove autistic children’s behavioral skills, it was determined that further studies need

done. Several of the articles did not include a large enough sample size to study. Music

therapy has the ability to improve behavioral skills. However, there was a lack of statistics

to help prove that skills developed better in children receiving music therapy compared to

children who did not receive music therapy. While music therapy seems to work, there is

an absence of statistical significance. This lack of statistical significance is most likely due to

small sample sizes. Music therapy showed to improve some behavioral skills, but not all.

Communication and social skills are difficult to test as each individual with autism mani-

fests differently. Emotional skills seemed to be the only skill that had statistics to prove that

it improved.
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Title: Effects of music therapy on Autism

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Gattino, G. S., Riesgo, R. S., Longo, D., Leite, J. L., & Faccini, L. S. (2011). Effects of relational
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study. Nordic Journal Of Music Therapy, 20(2), 142-154.
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