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Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial.

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.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

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    GAMUT-The Grieg Academy Music Therapy Research Centre, Uni Research Health, Uni Research, Bergen, Norway.

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    GAMUT-The Grieg Academy Music Therapy Research Centre, Uni Research Health, Uni Research, Bergen, Norway.

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    GAMUT-The Grieg Academy Music Therapy Research Centre, Uni Research Health, Uni Research, Bergen, Norway.

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    GAMUT-The Grieg Academy Music Therapy Research Centre, Uni Research Health, Uni Research, Bergen, Norway.

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    Melbourne Conservatorium of Music, University of Melbourne, Melbourne, Australia.

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    Department of Communication and Psychology, Aalborg University, Aalborg, Denmark. Postgraduate Program in Child and Adolescent Health, Faculty of Medicine, Rio Grande do Sul Federal University, Porto Alegre, Brazil.

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    School for Creative Arts Therapies, University of Haifa, Haifa, Israel.

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    Music Therapy Program, David-Yelin College, Jerusalem, Israel.

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    IRCCS Stella Maris Foundation, Pisa, Italy.

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    IRCCS Stella Maris Foundation, Pisa, Italy. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.

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    IRCCS Stella Maris Foundation, Pisa, Italy.

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    Jeonju University, Jeonju, South Korea.

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    Centre for Psychiatry, Imperial College London, London, United Kingdom.

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    Anglia Ruskin University, Cambridge, United Kingdom.

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    Anglia Ruskin University, Cambridge, United Kingdom.

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    Anglia Ruskin University, Cambridge, United Kingdom.

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    Anglia Ruskin University, Cambridge, United Kingdom. Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.

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    Rebecca Center for Music Therapy at Molloy College, Rockville Centre, New York.

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    Personal Social Services Research Unit, LSE Health and Social Care, The London School of Economics and Political Science, London, United Kingdom.

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    Villa Santa Maria Institute, Tavernerio, Italy.

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    GAMUT-The Grieg Academy Music Therapy Research Centre, Uni Research Health, Uni Research, Bergen, Norway.

    Source

    JAMA 318:6 2017 Aug 08 pg 525-535

    MeSH

    Attention
    Autism Spectrum Disorder
    Child
    Child, Preschool
    Female
    Humans
    Male
    Music Therapy
    Single-Blind Method
    Social Skills
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Multicenter Study
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    28787504

    Citation

    TY - JOUR T1 - Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial. AU - Bieleninik,Lucja, AU - Geretsegger,Monika, AU - Mössler,Karin, AU - Assmus,Jörg, AU - Thompson,Grace, AU - Gattino,Gustavo, AU - Elefant,Cochavit, AU - Gottfried,Tali, AU - Igliozzi,Roberta, AU - Muratori,Filippo, AU - Suvini,Ferdinando, AU - Kim,Jinah, AU - Crawford,Mike J, AU - Odell-Miller,Helen, AU - Oldfield,Amelia, AU - Casey,Órla, AU - Finnemann,Johanna, AU - Carpente,John, AU - Park,A-La, AU - Grossi,Enzo, AU - Gold,Christian, AU - ,, PY - 2017/8/9/entrez PY - 2017/8/9/pubmed PY - 2017/8/9/medline SP - 525 EP - 535 JF - JAMA JO - JAMA VL - 318 IS - 6 N2 - 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. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/28787504/Effects_of_Improvisational_Music_Therapy_vs_Enhanced_Standard_Care_on_Symptom_Severity_Among_Children_With_Autism_Spectrum_Disorder:_The_TIME_A_Randomized_Clinical_Trial_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2017.9478 ER -