When you think of need areas for children with autism, it is no doubt that emotional expression, social responsiveness, and behavioral/motivational aspects come to mind. Although there are differences between children who have an ASD, these are hallmark characteristics of the neurodevelopmental disorder. In a community that is built on social engagement (from expressing wants/needs to occupational situations) these skills can be essential to independent functioning. Some new research has begun to show that improvisational music therapy can be beneficial for children with an ASD.
When comparing Improvisational Music Therapy with play sessions, Kim, Wigram, & Gold (2009), found that children with ASD demonstrated more instances of emotional expression and social engagement when engaged in music therapy sessions than in play sessions. Furthermore, when the therapist placed demands on the child (directed style), the children responded more when engaged in music therapy. This study was on young children 3-5 years of age who had ASD characteristics as determined by the Childhood Autism Rating Scale (CARS).
A few points to ponder. As a Randomized Control Trial (RCT) study the study design is considered the “gold standard” for experimental research. As a profession we need more RCT studies to show treatment efficacy. This study was within-subjects, meaning each child went through both conditions (in a randomized order). In your textbook RCT there are two groups that are randomly selected (and therefore should be an equal representation of the population) and one undergoes treatment and the other is a control group. This type of research requires a lot of participants (typically you’d want a minimum of 15 per group; 30 would be better). For this reason (among others) you don’t see a lot textbook RCT studies in the music therapy literature.
The authors do a nice job of identifying the specific method used (improvisation) and even include a list of materials used (see article for more information). This is important for several reasons: 1) if you read about “the effect of music therapy” with no other information, you don’t really know what method of music therapy was used, which means you can’t determine the value of the information for your clinical practice, and 2) you want to be able to replicate research studies to see if the same results are obtained – if you don’t know what or how they applied “music therapy” there is little chance of replication.
Back to this Kim et al. study. There is no protocol listed (i.e., what types of things were completed in what order). This is probably due to the nature of improvisational therapy. Although there is no protocol, the authors do state that there were both child-directed and therapist-directed portions of the sessions, giving some indication of their interactions with the clients over the session.
The downside of this study was the population size – 15 participants started the study and after attrition there were 10. Thats a pretty high drop-out rate (1/3 left the study). What is excellent is that the authors CLEARLY state that attrition occurred and give some indications as to why. However, with so few participants it is hard to infer anything to the general population of children with autism.
What does this mean for clinical practice? First of all, children with ASD may respond well to Improvisational Music Therapy. If this is a method you are using there is some evidence showing improvements within the session (there were no measures of functional behaviors taken in non-intervention settings). Not using improvisational methods? Perhaps the most interesting finding was that the children were more responsive to directives when in music than in play. Many of us are very directive in music therapy sessions – we tell the child what to do and expect a response. This study did not look at a directive approach alone (it followed non-directive), but it is worth considering the use of both child-directed and tx-directed styles in your sessions. More research is needed to determine the effectiveness of these different approaches (directed, non-directed) in other music therapy methodologies.