The Effects of Improvisational Music Therapy on Joint Attention Behaviors in Autistic Children: A Randomized Controlled Study

Abstract

The purpose of this study was to investigate the effects of improvisational music therapy on joint attention behaviors in pre-school children with autism. It was a randomized controlled study employing a single subject comparison design in two different conditions, improvisational music therapy and play sessions with toys, and using standardized tools and DVD analysis of sessions to evaluate behavioral changes in children with autism. The overall results indicated that improvisational music therapy was more effective at facilitating joint attention behaviors and non-verbal social communication skills in children than play. Session analysis showed significantly more and lengthier events of eye contact and turn-taking in improvisational music therapy than play sessions. The implications of these findings are discussed further.

Joint Attention and Occupations for Children and Families Living with Autism Spectrum Disorder: A Scoping Review

“…Five studies featured multiple baseline single-group design, with a fewer number of participants ranging from two to six per study (Franco et al, 2013;Jones et al, 2006;Martins & Harris, 2006;Rocha et al, 2007;Vismara & Lyons, 2007). (Franco et al, 2013;Gulsrud et al, 2007;Jones et al, 2006;Kim et al, 2008Kim et al, , 2009Lawton & Kasari, 2012a, 2012bMartins & Harris, 2006;Schertz et al, 2013;Vismara & Lyons, 2007;Wong, 2013); response to JA and overall JA behaviors (Kasari et al, 2010;Kim et al, 2008;Rocha et al, 2007;Schertz et al, 2013;Wong, 2013); and initiating JA skills (Franco et al, 2013;Ingersoll, 2012;Jones et al, 2006;Kaale et & Kasari, 2012b;Rocha et al, 2007;Schertz et al, 2013;Vismara & Lyons, 2007;Yoder & Stone, 2006 (Chiang et al, 2016;Jones et al, 2006;Kasari et al, 2010;Rocha et al, 2007;Vismara & Lyons, 2007). Similar findings indicate that teachers of children living with ASD can effectively elicit JA skills in classroom settings following targeted intervention training from interventionists (Kaale et al, 2012;Lawton & Kasari, 2012b;…”

“…It was determined that all of the remaining studies in this analysis are classified as Level I, II, or III based on the AOTA evidence standards (AOTA, 2012). Of the 19 included studies, a majority (n = 13) featured randomized controlled trial (RCT) designs with subject numbers ranging from 10 to 61, with an average of 37 participants across all RCTs (Gulsrud et al, 2007;Ingersoll, 2012;Kaale et al, 2012;Kasari et al, 2006Kasari et al, , 2010Kim et al, 2008Kim et al, , 2009Lawton & Kasari, 2012a, 2012bSchertz et al, 2013;Wong, 2013;Wong et al, 2007;Yoder & Stone, 2006). One study featured a non-randomized controlled trial design, with an equivalent sample size of 34 participants (Chiang et al, 2016).…”

“…Fourteen studies used structured or standardized assessments, contributing to the strength of the research findings (Chiang et al, 2016;Franco et al, 2013;Ingersoll, 2012;Kaale et al, 2012;Kasari et al, 2006Kasari et al, , 2010Kim et al, 2008;Lawton & Kasari, 2012a, 2012bRocha et al, 2007;Schertz et al, 2013;Wong, 2013;Wong et al, 2007;Yoder & Stone, 2006). Of the studies that incorporated video recording for the purpose of analyzing observational data, nearly all of them used some combination of blinded, independent assessors to code data with documentation of acceptable levels of interobserver agreement, thus contributing to the strength of the experimental design (Chiang et al, 2016;Franco et al, 2013;Gulsrud et al, 2007;Jones et al, 2006;Kaale et al, 2012;Kasari et al, 2010;Kim et al, 2009;Lawton & Kasari, 2012b;Schertz et al, 2013;Vismara & Lyons, 2007;Wong, 2013;Yoder & Stone, 2006).…”

“…JA intervention (JAI) is defined as the teaching of JA skills, and this approach to intervention has been researched extensively in the past decade (Chiang et al, 2016;Franco, Davis, & Davis, 2013;Gulsrud, Kasari, Freeman, & Paparella, 2007;Ingersoll, 2012;Jones, Carr, & Feeley, 2006;Kaale, Smith, & Sponheim, 2012;Kasari, Freeman, & Paparella, 2006;Kasari et al, 2010;Kim, Wigram, & Gold, 2008, 2009Lawton & Kasari, 2012a, 2012bMartins & Harris, 2006;Rocha, Schreibman, & Stahmer, 2007;Schertz, Odom, Baggett, & Sideris, 2013;Vismara & Lyons, 2007;Wong, 2013;Wong, Kasari, Freeman, & Paparella, 2007;Yoder & Stone, 2006). JA teaching strategies tend to incorporate principles from applied behavior analysis in the context of a table-top play routine or a naturalistic play setting (Kasari et al, 2010).…”

Complementary and Alternative Medicine in Autism: An Evidence-Based Approach to Negotiating Safe and Efficacious Interventions with Families

“…A 2006 Cochrane review of music therapy in ASD concluded that music therapy was "superior to 'placebo' therapy with respect to verbal and gestural communicative skills," but effects on behavior were not significant; the authors noted also that the studies were of "limited applicability to clinical practice" and that more research is needed to establish whether the effects of music therapy are lasting. 47 Two recent randomized controlled studies, by the same researchers, 48,49 used a single-subject comparison design to compare improvisational music therapy to play sessions with toys. They found the intervention superior to play at facilitating joint attention behaviors, nonverbal social communication skills, more and longer events of "joy," "emotional synchronicity," and "initiation of engagement" behaviors in children, and a phenomenon that the authors described as "more yes, less no."…”