Complementary and Alternative Therapies for Autism Spectrum Disorder

Table 5

Music therapies in ASD.

Author	Year	Type and duration of study	Sample size	Type of intervention	Comparators	Dose	Outcome measure	Findings	Comments
Arezina [51]	2011	Randomized, crossover; Duration: 5 weeks	(M 5; F 1); Age: 36–64 months	Interactive MT (musical instrument play, songs, music, books)	(1) Nonmusic interactive play (nonmusic toys and books); (2) Independent play	18 sessions of 10 minutes each	Behavior observation of videotaped sessions	Significant more interactions during interactive music therapy than the two comparator groups.; Significant more requesting during interactive than independent play, but no effect of music	Blinding not reported; No details about diagnostic process; No baseline assessment of functioning; Small sample size; No standardized outcome measures; No accounting for potential confounders (medication, other therapies)
Brownell [52]	2002	Randomized, crossover; Duration: 4 weeks	(M 4; F 0); Age: 6–9 years	Structured receptive MT (songs with social stories)	(1) Structured receptive “story therapy” (reading of social stories); (2) No intervention, (5 days)	5 individual daily sessions	Repetitive behaviors outside therapy sessions (in classroom)	No difference	Blinding not reported; No details about diagnostic process; Small sample size; No standardized outcome measures; No accounting for potential confounders (medication, other therapies)
Buday [53]	1995	Randomized, single blind, crossover; Duration: 2 weeks	(M 8; F 2); Age: 4–9 years	Structured receptive MT (songs used to teach signs)	“Rhythm therapy” (rhythmic speech used to teach signs)	5 individual sessions	Imitating behavior in sessions (sign and speech imitation)	Significant improvement of imitation in the music versus rhythmic conditions	Small sample size; No details about diagnostic process; No standardized outcome measures; No accounting for potential confounders (medication, other therapies)
Farmer [54]	2003	Randomized, parallel group; Duration: 5 days	(M 9; F 1); Age: 2–5 years	Music therapy sessions (combined active and receptive: guitar playing, songs),	Placebo (no music) sessions,	5 individual sessions of 20 minutes	Responses within sessions: (a) verbal responses,; (b) gestural responses	Significant increase in verbal responses in the music group versus placebo. No significant difference in gestural responses	Blinding not reported; No details about diagnostic process; Small sample size; No standardized outcome measures; No accounting for potential confounders (medication, other therapies); Number of subjects per session varies
Gattino et al. [55]	2011	Randomized, single blind, parallel group; Duration: 7 months	(M 24; F 0); Age: 7–12 years	Relational music therapy (improvisation not using a structured protocol) plus standard care,	Standard treatment (clinical routine activities),	20 thirty-minute sessions, scheduled weekly	CARS, Brazilian version	No statistical difference between the two groups. Subgroup analysis on nonverbal communication showed improvement in the music group	Single blind; Small sample size; No accounting for potential confounders (medication, other therapies)
Kim et al. [56]	2008	Randomized, single blind, crossover; Duration: 8 months	(M 13; F 2); drop-out (M 3; F 2); Age: 39–71 months; Diagnosis of ASD by two child psychiatrists	Improvisational music therapy	Play sessions with toys	12 thirty-minute sessions, scheduled weekly	PDD-BI, ESCS, eye contact frequency and duration, initiation of engagement frequency, emotional synchronicity frequency and duration, musical synchronicity frequency and duration, number of compliant-no compliant and absent responses, joy frequency and duration	Significant improvement only in ESCS score after music therapy compared to play (medium effect size). Eye contact was longer in music therapy than in play	Single blind (additionally, assessors were not blinded to all outcome measures, in particular to ESCS); Small sample size; No accounting for potential confounders (medication, other therapies); High drop-out rate; Statistical analysis performed only in completers
Lim [57]	2010	Randomized, single blind, parallel group; Duration: 5 days	(M 44; F 6); Age: 3–5 years	Music training (“Developmental Speech and Language Training through Music”; videotaped songs with target words),	(1) Speech training (videotaped spoken stories with target words),; (2) No training,	6 individual sessions within 3 days	Behavior observation (verbal response) of videotaped posttest sessions	No differences between music and speech therapy (improvement in both groups versus no treatment).; Higher improvement in low functioning children	Single blind; No standardized outcome measures; No details about the diagnostic process; No accounting for potential confounders (medication, other therapies)
Lim and Draper [58]	2011	Randomized, single blind, crossover; Duration: 2 weeks	(M 17; F 5); Age: 3–5 years	Applied Behavior Analysis Verbal Behavior plus Music Training (sung instructions, songs with target words)	(1) Applied Behavior Analysis Verbal Behavior; (2) No training	6 individual sessions within 2 weeks	Behavior observation (verbal production) of videotaped posttest sessions	No statistically significant difference between the two treatment groups	Single blind; Small sample size; No standardized outcome measures; No details about the diagnostic process; No accounting for potential confounders (medication, other therapies)
Thomas and Hunter [59]	2003	Randomized, crossover; Duration: 12 weeks	(M 5; F 1); Age: 2-3 years	Music therapy (songs, instruments, vocal sounds, and movement to interact with the child, musical or verbal response to the child’s behavior)	Playtime (interact with the child using toys and verbal response to the child’s behavior)	Twelve 15-minute sessions	Behavior observation (on-task and requesting) of videotaped sessions, assessed as percentage of session time	Significant improvement in social adaptation and initiating behaviors in the music compared to play	Blinding not reported; Small sample size; No standardized outcome measures; No accounting for potential confounders (medication, other therapies)
Thompson [60]	2012	Randomized, parallel group; Duration: 12 weeks	(M 19; F 4); Age: 3–6 years	Home-based, family-centred music therapy (songs, improvisation, structured music interactions), plus standard care,	Standard care,	16 sessions, scheduled weekly	Vineland SEEC, SRS-Preschool Version (parent rated), MBCDI-Words and Gestures (parent-rated) PCRI (parent-rated)	Statistical significant difference between active treatment and control in the primary outcome (Vineland SEEC-socialization). No statistical difference in the other scales	Parent not blinded to the intervention; Small sample size
Boso et al. [61]	2007	Open label; Duration: 52 weeks	(M 7; F 1); Age: 23–38 years	Interactive music therapy (singing, piano playing, and drumming)	None	1 hour/week	CGI-Severity; CGI-Improvement, BPRS	Statistically significant improvements on the CGI-Severity; CGI-Improvement, and BPRS scale	Open label trial (no randomization, no control group); Raters not blinded; Small sample size
Iseri [62]	2014	Open label; Duration: 4–8 months	(M 6; F 4); Age: 6–15 years	Music therapy	None	One 5-hour MT session/month	CARS, Neurohormonal responses (cortisol, adrenalin, noradrenalin, ACTH)	Decreasing scores at CARS.; No statistical differences between hormone levels before and after therapy	Open label trial (no randomization, no control group); Small sample size; Unclear duration; Unclear compliance
Kalas [63]	2012	Crossover; Duration: 3 weeks	(M 28; F 2); (15 mild/moderate ASD, 15 severe ASD); Age: 4–6 years	Simple music listening	Complex music listening	Six, 10-minute individual music conditions (3 simple and 3 complex)	Responses to joint attention	Higher joint attention in the simple music condition for severe ASD.; Higher joint attention in the complex music condition for mild/moderate ASD	No randomization; Blinding not reported; No standardized outcome measures
Lundqvist et al. [64]	2009	Randomized, crossover; Duration: 10 weeks	(M 13; F 7); Age: 22–57 years; Diagnosis of ASD only in 10 patients; each patient had a diagnosis of mental retardation	Vibroacoustic music treatment (5 weeks)	Placebo = no treatment (5 weeks)	Two 20 min sessions per week	BPI (self-injurious behavior; stereotypical behavior; aggressive behavior); Behavior observation analysis by video recording	In ASD, vibroacoustic music statistically reduced self-injurious, behaviors. No other effect was observed	Blinding not reported; Small sample size; Not specific for ASD diagnosis (they included mental retardation); No accounting for potential confounders (medication, other therapies); Only one standardized measure
Schwartzberg; and Silverman [65]	2013	Cluster randomized, placebo controlled (three different clusters according to the social story type); Duration: 3 weeks	(no data on age or gender); Completers; (M 29; F 1) Age: 9–21 years	Music therapy groups (social story sung to them)	Nonmusic control groups (social story read to them)	50-min music therapy session/day per 1 week	ASSP (parent-rated 1 week before treatment and posted 1 week after); Five comprehension check questions	No significant difference between groups	Blinding not reported; High drop-out rate (no information provided); Only per protocol analysis; No accounting for potential confounders (medication, other therapies)

ASD, autism spectrum disorder; ASSP, Autism Social Skills Profile; BPI, Behavior Problems Inventory; BPRS, Brief Psychiatric Rating Scale; CARS, Childhood Autism Rating Scale; CGI, Clinical Global Impression; ESCS, Early Social Communication Scale; MBCDI, MacArthur-Bates Communicative Development Inventories; PCRI, Parent-Child Relationship Inventory; PDD-BI, Pervasive Developmental Disorder-Behavior Inventory; SRS, Social Responsiveness Scale; Vineland SEECS, Vineland Social Emotional Early Childhood Scales.