Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial
IMPORTANCE: Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. OBJECTIVE: To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. DESIGN, SETTING, AND PAR...
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| Published in | JAMA : the journal of the American Medical Association Vol. 318; no. 6; pp. 525 - 535 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Medical Association
08.08.2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0098-7484 1538-3598 1538-3598 |
| DOI | 10.1001/jama.2017.9478 |
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| Abstract | IMPORTANCE: Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. OBJECTIVE: To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. DESIGN, SETTING, AND PARTICIPANTS: Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. INTERVENTIONS: Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child’s focus of attention, to help children develop affect sharing and joint attention. MAIN OUTCOMES AND MEASURES: The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. RESULTS: Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, −0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference. CONCLUSIONS AND RELEVANCE: Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN78923965 |
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| AbstractList | IMPORTANCE: Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. OBJECTIVE: To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. DESIGN, SETTING, AND PARTICIPANTS: Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. INTERVENTIONS: Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents' concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child's focus of attention, to help children develop affect sharing and joint attention. MAIN OUTCOMES AND MEASURES: The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. RESULTS: Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314(86%) completed the primary end point and 290(80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, -0.70 to 0.81]; p = .88). with no significant difference in improvement. Of 20 exploratory secondary outcomes. 17 showed no significant difference. CONCLUSIONS AND RELEVANCE: Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder. Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents' concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child's focus of attention, to help children develop affect sharing and joint attention. The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, -0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference. Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder. isrctn.org Identifier: ISRCTN78923965. IMPORTANCE: Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. OBJECTIVE: To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. DESIGN, SETTING, AND PARTICIPANTS: Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. INTERVENTIONS: Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child’s focus of attention, to help children develop affect sharing and joint attention. MAIN OUTCOMES AND MEASURES: The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. RESULTS: Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, −0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference. CONCLUSIONS AND RELEVANCE: Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN78923965 Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication.ImportanceMusic therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication.To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD.ObjectiveTo evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD.Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016.Design, Setting, and ParticipantsAssessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016.Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents' concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child's focus of attention, to help children develop affect sharing and joint attention.InterventionsEnhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents' concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child's focus of attention, to help children develop affect sharing and joint attention.The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months.Main Outcomes and MeasuresThe primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months.Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, -0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference.ResultsAmong 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, -0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference.Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder.Conclusions and RelevanceAmong children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder.isrctn.org Identifier: ISRCTN78923965.Trial Registrationisrctn.org Identifier: ISRCTN78923965. This randomized trial evaluated the effects of improvisational music therapy vs enhanced standard care on generalized social communication skills of children with autism spectrum disorder. |
| Author | Thompson, Grace Elefant, Cochavit Finnemann, Johanna Carpente, John Gattino, Gustavo Park, A-La Geretsegger, Monika Gold, Christian Igliozzi, Roberta Assmus, Jörg Kim, Jinah Grossi, Enzo Suvini, Ferdinando Muratori, Filippo Mössler, Karin Bieleninik, Lucja Crawford, Mike J Odell-Miller, Helen Oldfield, Amelia Casey, Órla Gottfried, Tali |
| AuthorAffiliation | 10 Centre for Psychiatry, Imperial College London, London, United Kingdom 11 Anglia Ruskin University, Cambridge, United Kingdom 5 School for Creative Arts Therapies, University of Haifa, Haifa, Israel 3 Department of Communication and Psychology, Aalborg University, Aalborg, Denmark 2 Melbourne Conservatorium of Music, University of Melbourne, Melbourne, Australia 15 Villa Santa Maria Institute, Tavernerio, Italy 13 Rebecca Center for Music Therapy at Molloy College, Rockville Centre, New York 4 Postgraduate Program in Child and Adolescent Health, Faculty of Medicine, Rio Grande do Sul Federal University, Porto Alegre, Brazil 6 Music Therapy Program, David-Yelin College, Jerusalem, Israel 7 IRCCS Stella Maris Foundation, Pisa, Italy 14 Personal Social Services Research Unit, LSE Health and Social Care, The London School of Economics and Political Science, London, United Kingdom 1 GAMUT—The Grieg Academy Music Therapy Research Centre, Uni Research Health, Uni Research, Bergen, Norway 8 Department |
| AuthorAffiliation_xml | – name: 13 Rebecca Center for Music Therapy at Molloy College, Rockville Centre, New York – name: 10 Centre for Psychiatry, Imperial College London, London, United Kingdom – name: 12 Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom – name: 5 School for Creative Arts Therapies, University of Haifa, Haifa, Israel – name: 11 Anglia Ruskin University, Cambridge, United Kingdom – name: 15 Villa Santa Maria Institute, Tavernerio, Italy – name: 8 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy – name: 14 Personal Social Services Research Unit, LSE Health and Social Care, The London School of Economics and Political Science, London, United Kingdom – name: 7 IRCCS Stella Maris Foundation, Pisa, Italy – name: 2 Melbourne Conservatorium of Music, University of Melbourne, Melbourne, Australia – name: 6 Music Therapy Program, David-Yelin College, Jerusalem, Israel – name: 4 Postgraduate Program in Child and Adolescent Health, Faculty of Medicine, Rio Grande do Sul Federal University, Porto Alegre, Brazil – name: 9 Jeonju University, Jeonju, South Korea – name: 3 Department of Communication and Psychology, Aalborg University, Aalborg, Denmark – name: 1 GAMUT—The Grieg Academy Music Therapy Research Centre, Uni Research Health, Uni Research, Bergen, Norway |
| Author_xml | – sequence: 1 givenname: Lucja surname: Bieleninik fullname: Bieleninik, Lucja – sequence: 2 givenname: Monika surname: Geretsegger fullname: Geretsegger, Monika – sequence: 3 givenname: Karin surname: Mössler fullname: Mössler, Karin – sequence: 4 givenname: Jörg surname: Assmus fullname: Assmus, Jörg – sequence: 5 givenname: Grace surname: Thompson fullname: Thompson, Grace – sequence: 6 givenname: Gustavo surname: Gattino fullname: Gattino, Gustavo – sequence: 7 givenname: Cochavit surname: Elefant fullname: Elefant, Cochavit – sequence: 8 givenname: Tali surname: Gottfried fullname: Gottfried, Tali – sequence: 9 givenname: Roberta surname: Igliozzi fullname: Igliozzi, Roberta – sequence: 10 givenname: Filippo surname: Muratori fullname: Muratori, Filippo – sequence: 11 givenname: Ferdinando surname: Suvini fullname: Suvini, Ferdinando – sequence: 12 givenname: Jinah surname: Kim fullname: Kim, Jinah – sequence: 13 givenname: Mike J surname: Crawford fullname: Crawford, Mike J – sequence: 14 givenname: Helen surname: Odell-Miller fullname: Odell-Miller, Helen – sequence: 15 givenname: Amelia surname: Oldfield fullname: Oldfield, Amelia – sequence: 16 givenname: Órla surname: Casey fullname: Casey, Órla – sequence: 17 givenname: Johanna surname: Finnemann fullname: Finnemann, Johanna – sequence: 18 givenname: John surname: Carpente fullname: Carpente, John – sequence: 19 givenname: A-La surname: Park fullname: Park, A-La – sequence: 20 givenname: Enzo surname: Grossi fullname: Grossi, Enzo – sequence: 21 givenname: Christian surname: Gold fullname: Gold, Christian |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28787504$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Copyright American Medical Association Aug 8, 2017 Copyright 2017 American Medical Association. All Rights Reserved. |
| Copyright_xml | – notice: Copyright American Medical Association Aug 8, 2017 – notice: Copyright 2017 American Medical Association. All Rights Reserved. |
| CorporateAuthor | for the TIME-A Study Team TIME-A Study Team |
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| DOI | 10.1001/jama.2017.9478 |
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| DocumentTitleAlternate | Improvisational Music Therapy in Autism Spectrum Disorder |
| EISSN | 1538-3598 |
| EndPage | 535 |
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| References | 33847728 - JAMA. 2021 Apr 13;325(14):1473. doi: 10.1001/jama.2021.4108. 28787492 - JAMA. 2017 Aug 8;318(6):523-524. doi: 10.1001/jama.2017.9477. |
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| Snippet | IMPORTANCE: Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. OBJECTIVE:... Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. To evaluate effects of... Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication.ImportanceMusic therapy... This randomized trial evaluated the effects of improvisational music therapy vs enhanced standard care on generalized social communication skills of children... |
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| SubjectTerms | Attention Autism Autism Spectrum Disorder - psychology Autism Spectrum Disorder - therapy Autistic children Child Child, Preschool Children Children & youth Clinical trials Communication skills Diagnostic systems Female Humans Male Music Therapy Original Investigation Parents Single-Blind Method Social Skills Therapy Treatment Outcome |
| Title | Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial |
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