Table 5: Music therapies in ASD.

Author Year Type and duration of study Sample size Type of intervention ComparatorsDose Outcome measureFindings Comments

Arezina [51]2011Randomized, 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 sessionsSignificant 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]2002Randomized, 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 sessionsRepetitive behaviors outside therapy sessions (in classroom)No differenceBlinding not reported  
No details about diagnostic process  
Small sample size  
No standardized outcome measures  
No accounting for potential confounders (medication, other therapies)

Buday [53]1995Randomized, 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 sessionsImitating 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]2003Randomized, 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 minutesResponses 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]2011Randomized, 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 weeklyCARS, Brazilian versionNo statistical difference between the two groups. Subgroup analysis on nonverbal communication showed improvement in the music groupSingle blind  
Small sample size  
No accounting for potential confounders (medication, other therapies)

Kim et al. [56]2008Randomized, 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 therapyPlay sessions with toys12 thirty-minute sessions, scheduled weeklyPDD-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 durationSignificant 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]2010Randomized, 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 daysBehavior observation (verbal response) of videotaped posttest sessionsNo 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]2011Randomized, 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 weeksBehavior observation (verbal production) of videotaped posttest sessionsNo statistically significant difference between the two treatment groupsSingle 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]2003Randomized, 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 timeSignificant improvement in social adaptation and initiating behaviors in the music compared to playBlinding not reported  
Small sample size  
No standardized outcome measures  
No accounting for potential confounders (medication, other therapies)

Thompson [60]2012Randomized, 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 weeklyVineland 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 scalesParent not blinded to the intervention  
Small sample size

Boso et al. [61]2007Open label  
Duration: 52 weeks
(M 7; F 1)  
Age: 23–38 years
Interactive music therapy (singing, piano playing, and drumming)None1 hour/weekCGI-Severity; CGI-Improvement, BPRSStatistically significant improvements on the CGI-Severity; CGI-Improvement, and BPRS scaleOpen label trial (no randomization, no control group)  
Raters not blinded  
Small sample size

Iseri [62]2014Open label  
Duration:  
4–8 months
(M 6; F 4)  
Age: 6–15 years
Music therapyNoneOne 5-hour MT session/monthCARS, 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]2012Crossover  
Duration: 3 weeks
(M 28; F 2)  
(15 mild/moderate ASD, 15 severe ASD)  
Age: 4–6 years
Simple music listening Complex music listeningSix, 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]2009Randomized, 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 weekBPI (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 observedBlinding 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]
2013Cluster 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 groupsBlinding 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.