Benefits of Music Therapy on the Social Skills of Children with Autism Spectrum Disorder

Benefits of Music Therapy on the Social Skills of Children with Autism Spectrum Disorder

Dear Professor,

In this draft, I am trying to argue that music therapy is an effective treatment for improving the social skills of children with autism spectrum disorder. The points I use in this paper is to first define what social skills are and how the social deficits, turn taking, and eye contact have an effect on the ability of a child with ASD. I arrived to my core ideas for this draft by researching on the UConn databases and finding studies on positive results of the social skills of children with autism. I think one of the strongest parts of the draft is my introduction, I think I did well introducing the topic and stating my stance for this paper. What I struggled with the most was rewriting the evidence I found in the articles into my own words. My top two priorities for revising are to make sure that the essay flows and that I provide good and enough evidence for each one of my points.

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Autism Spectrum Disorder is a neurodevelopmental disorder that depicts a range of deficits in social skills and communication, including restricted and repetitive patterns of behaviors (Ledford, King, Harbin, & Zimmerman, 2018). Furthermore, to be diagnosed with ASD, the social communication functioning must be impaired compared to peers of the same age and these symptoms must limit the child with their everyday functions. This disorder is more prevalent in boys than in girls, occurring in 1 in 68 children (Crane, 2016). The cause is unknown, however, we do know characteristics that come with it, one being social deficits. Social skills are crucial to a child’s development because without them they wouldn’t be able to obtain higher functions, for instance, social interactions, communication, or language. There are many therapies that are used for children with autism, but only a few that yield effective results. A couple of studies on music therapy have shown a positive correlation on the social skills of children diagnosed with ASD because it engages the child at their own level and interest. Music therapy is when music is used for non-musical means such as to improve socialization, emotion, behavior, and communication for children with ASD (Bharathi, Venugopal, & Vellingiri, 2019). While being effective on the social skills, music therapy also leads to a positive correlation on improvement of mood, behavior, and language as well. Music gives an individual the opportunity to express themselves, communicate, and form interactions with others (Kim, Wigram, & Gold, 2008). A variety of studies have been administered, gathering data on the effects that music therapy has on certain social skills of children with ASD. Music therapy is an effective treatment for children in the Autism Spectrum that shows a high level of increase in positive results regarding improvements on social skills deficit, a core feature of ASD. Improvements are easily observed and displayed by eye contact, turn taking, and overall communication in a variety of results from different studies. Through qualitative and quantitative data gathered from different researchers, music therapy’s effectiveness is consistent and strong throughout the studies and shows a clear connection and relationship to the improvement of social skills in young and developing children.

Introduction to Social Deficits in Autism Spectrum Disorder:

One of the most relevant and predominant indicators in diagnostics for children with autism spectrum disorder is social deficits (Ledford, et al., 2018). Autism has an effect on an individual’s social and communication competencies and these symptoms are shown within the first three years of life of those diagnosed with ASD (Bharathi, Venugopal, & Vellingiri, 2019). Social deficits may negatively impact mood, behavior, and language in later development. Social deficits in children with ASD are caused by alterations of the brain structure and function (Pina‐Camacho et al., 2012). Their impairments may never fully develop nor completely repaired but may be improved with treatments throughout time and constant care taking. The goal for improvements in social deficits is for a child to excel in many other aspects as well, including, becoming more interactive when communicating, improvement within their behavioral patterns, positive mood enhancement, and overall social skills. Two major social deficits of children with ASD, that will be further discussed in this paper, are eye contact and turn taking. Both eye contact and turn taking are two critically important social skills needed in every person’s daily life routine because it allows an individual to maintain interactions and focus on what is being said when communicating with others. It allows information retainment as well as better understanding of what is being communicated. When enhanced and further improved, both of these targeted behaviors may alter other abilities as well, such as the general behavior, mood changes, and language of the child. With the interactions that are established in music therapy, an individual with autism will improve in the duration of time making eye contact while communicating with individuals better strengthening and enhancing the intervals of attention. Increase in the amount of times they could take turns and the length of the turns would also improve and be observed. Because of these improvements, it is vital that music therapy be validated and established in order to further increase in the enhancement of social skills deficits within children in the Autism Spectrum.

Affective engagement and long-term development of overall cognitive and language characteristics of social interaction and communication may be gravely impacted by the processing of sensorimotor information. Because of these deviations, apparent behaviors which facilitate social interaction and the engagement of it such as; eye contact, imitation, and turn taking may be affected in ASD. It is important to state that a child’s interest might be higher in the engagement with objects rather than other individuals in the child’s life. The display of atypical and negative behaviors such as; aggressive moods or attitudes, as well as a proneness to self stimulation or injury may be caused in children with ASD because of dysregulation within emotional perception. In addition to this, the relationships shared between the family, other individuals, and even the therapist with the child may be damaged and left in a shaky stance.

Social Deficits: Turn Taking, Eye Contact, and Imitating

Social interactions within music therapy can help with improving the social deficits of turn taking and eye contact in children with autism spectrum disorder. The working definition of eye contact is when a child is looking at the therapist while engaging in an event with them through play, the touching of objects or instruments, or other interactional situations between the therapist and the child. Furthermore, turn taking is defined as having the ability to take turns with another person in succession and through music therapy amount of times children with ASD can take turns increases and grows in time length as well (Kim, et al., 2008). For children with ASD, they must be able to hold eye contact with the therapist and learn to alternate turns with them as well throughout their music therapy sessions. During treatment, these skills can be measured by the frequency of eye contact or turn taking and the duration of it; the time during which the child holds eye contact or the amount of turns the child takes and alternates with the therapist. These skills are to be improved in a child so that they can communicate more efficiently with their peers or family.

A randomized control study, performed by Kim, Wigram, and Gold (2008), investigated how effective improvisational music therapy is on eye contact and turn taking in children with ASD undergoing their preschool year. This study compared two different conditions between one another; Improvisational music therapy versus play sessions. Improvisational music therapy was used because it is highly engaging and peaks the interest of child with autism at their own respective levels and interests. Eye contact and turn taking within the two sessions were measured by frequency and duration. Without eye contact and turn taking, children with autism, would not be able to perform higher functions and they wouldn’t be able to further develop and grow socially. This study involved 10 boys, diagnosed with autism, of the ages 3-5 years old. 5 of the boys were non verabal and the other 5 were verbal with limited language skills. This treatment included a 24 session program with 12 weekly improvisational music therapy sessions and another 12 weekly 30 minute play sessions. Randomly placed, one group of five children had the music therapy session first and the play session second, whereas, group two had their play session first and the music therapy second. For each session, in both conditions, it was child-led in which the therapist followed what the child wanted to do. The other 15 minutes was when the therapist used modeling and turn taking activities. Each session contained a different toy and different instrument that the child was allowed to use. The results showed that there were greater improvements of both, eye contact and turn taking, after music therapy than after play, suggesting that music therapy is more effective. The study provides evidence with graphs that represent the duration of eye contact and a separate graph of the duration of turn taking between the two sessions. Eye contact duration while in music therapy was significantly longer than during play. As for turn taking, it was also longer in music therapy but the second half, when the therapist facilitated modeling activities for the child, was a longer duration overall. Music therapy was favorable out of the two condition because it provided positive outcomes with the social skills. Their improvements offers communicative behaviors and developmental gains in language. Three of the five non verbal children begin to develop language skills due to the music therapy session. The findings indicated developing social skills through the use of music therapy.

A study by Vaiouli (2014) was conducted in order to prove that eye contact and turn taking within children with autism at a very young age could be promoted by improvisational music therapy intervention. This intervention involved interaction between the parents and their  child in order to create trust and ease within the child. In addition to this, the study took place in their home which further increased the feeling of safety and security for the child. One of the participants in this study was a child of 31 months of age who was at risk for being diagnosed with autism. Throughout five months, testing was done with the child in order to measure the relationship between music therapy and the child’s performance in social competence. This was composed of three stages regarding facial focusing, response to joint attention, and joint attention initiation. These three stages were then used in order to measure the behaviors that were being displayed by the child through a detailed coding manual. While that was being measured, a separate independent coder was in charge of 10 minute weekly videotaped intervention samplings for all participants that indicated whether the behaviors occurred or not. The testing demonstrated high levels of the behaviors needed to be displayed within the results. When the stage of this testing were introduced, the first stage demonstrated a change in mean of 1.35 in face focusing. The second stage showed a progressive incrementation with a mean change of 2.72 for the responses to joint attention. Finally, the toddler demonstrated independence when initiating actions involving joint attention that were shown in the results by a mean of 1.9. These behaviors were in a repetitive cycle within the first month of the intervention. Through observation and parent interviewing an increase in both communication occurrences among the child’s family members and the child sharing was seen by applying the use of music. The parents also stated in their interviews that the child demonstrated domination over generalization of actions involving joint engagement within other natural and familiar environments. In order to promote joint engagement, participation, and overall development within young children with ASD, music therapy incorporates family and child focused development tactics for a more noticeable increase in these characteristics of any child’s daily routine. This evidence promotes the use of music therapy to increase eye contact within communication as well as turn taking in young children with ASD.

Effects of Improved Social Skills

Mood, behavior, language, and social interactions may be altered from the social skills gained through music therapy. As it was mentioned before, music therapy allows the ability to express one’s self and to do it at their level. The use of turn taking and eye contact during communication, is a form of practice which results in a child to develop better language skills and social interactions. Social peer interactions may be enhanced through the use of music. Crane (2016), mentions a study done by Kern and his colleagues (2006), in which they placed a music center outside in a playground. This provided children with ASD to interact with peers while producing music next to each other. If a group of children work together, this allows for turn taking and initiative communication between peers. Also, allowing a child to structure their own music, will give them the chance to build a relationship with the therapist and communicate their own emotions through the music, which may indicate how they usually behave in their everyday life. Their behavior and mood may also be reinforced musically, an example that Crane (2016) provides is rewarding a child with playing an instrument longer if they exhibit good behavior in their session. Music therapy is beneficial in many ways because it permits the potential to respond, listen, share ideas, and share instruments, and provides a safe environment for the children to progress in many skills (Adamek and Darrow, 2010).

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Autism is a psychological developmental disorder that starts in early childhood. This disorder comes with abnormalities that affects the child’s everyday life, symptoms vary in severity. Shi, Lin, and Xie (2016) conducted a literature search where they evaluated the effects of music therapy on mood, language, behavior, and social interactions of a child with autism. This meta analysis included searching through databases to find studies relevant to finding the best intervention of music therapy.The terms they used were “music therapy,” “music treatment,” “autistic children,” and “children with autism.” After researching, they found 6 relevant articles and combined all experimental data; Each of these studies showed differences in the scores of mood, language, behavior, and social skills between the control and experimental group, after intervention. These studies indicated improvement in all aspects that were mentioned, in children with ASD. Even with the lack of language skills, children with ASD are still interested in music, and have great abilities in sound discrimination. Music therapy has unique advantages because it can further progress a child’s brain development while also easing the development of many more competencies. In addition, it increases their desire to participate in learning and social activities. Music intervention can be used to facilitate mental and physical health, which is associated with the development of language, social skills, and mood in children with autism.

Children with autism spectrum disorder need a fair amount of support if they do not have the capacity to socially interact. This can negatively impact the child’s social communication development. There are now relationship-based approaches to foster opportunities for interactions, turn taking, and joint attention when using music. (Geretsegger et al. 2012). The goal of this approach is to motivate a child to interact and connect with peers (Gattino et al. 2011). A family centered intervention will enhance the parent-child relationship while also developing skills in a child (Oldfield et al. 2012). Family-centered music therapy aids the social engagement between with a child with autism and his or her family members with the use of music making.

Promotion of relational experiences which focuses on a client’s expressions and interests is encouraged and often utilized in music therapy. This approach regarding autism treatment proves to be growingly effective in children with ASD and greatly changes the trajectory of and impacts a child’s developmental outcome. These developmental outcomes such as; communication and social skills as well as overall social interaction are critical and central to the needs of a child with ASD. Because of this, it is gaining more back up from researchers and validation for the tactics within this treatment for children with ASD and is now being considered a promising approach with highly effective outcomes for these kids as well as their respective families (Mössler et al., 2017).

Thompson,  McFerran, & Gold (2013), conducted a study with an aim to investigate the effects of family centered music therapy on social skills of the client. There was a sample size of 23 children diagnosed with ASD between the ages of 3-6 years with limited to non verbal communication that attended a family centered group therapy programme. These children randomly placed in groups, the treatment group contained 12 children that received 16 weeks of family centered music therapy with an early intervention programme. The control group contained 11 children that received early intervention programme only. Measures were taken based on parent interviews, standardized parent report assessments, and clinician observations. The family centered music therapy consisted of 16 week treatment sessions, once a week from 30-40 minutes with an active interaction of the child’s parents during music making activities. A variety of methods were used such as the use of songs and improvisation and relate to their behaviors through music. Musical activities were planned out to address social communication, 5 aspects were: shared attention, focus on faces, turn taking, response to joint attention, and initiation of joint attention Thompson, et al., 2013). Parents saw a positive change in their child’s social interactions at home and even outside of home. The change scores for the Vineland Social-Emotional Early Childhood Scales, of the children in music therapy was significantly greater than those that attended standard care only. The results should positive changes in the parent-child relationship, this was experienced by having the ability to interact with one another in which the parent was able to ‘see the child rather than the autism.’ From participation in this therapy, there was active engagement with parent and child which encouraged positive emotional responses. This study was focused on social skills which allows the child to improve in quality of developmental factors such as an increase in social interaction and positive behaviour with the family. Music making provides opportunities to develop interaction skills, thus, interactions open opportunities to develop socially and linguistically.

Evidence Against the use of Music Therapy

The core feature of autism spectrum disorder is the impairment of social communication and interaction. Using music as a medium, has potential in increasing social interactions. Many randomized studies have shown the positive correlations of music therapy on social interaction, joint attention, and parent-child relationships. Bieleninik, Geretsegger, Mössler, Assmus, Thompson, and Gattino (2017), suggest that there is a lack of evidence on longer term effects. The authors conducted a study with 364 participants of 4-6 years diagnosed with ASD from 9 different countries. Each were randomly assigned to one of the three interventions: 92 participants in low intensity music therapy with standard care (once per week), 90 participants in high intensity music therapy with standard care (three times per week), and 182 participants in standard care alone. Music therapy was provided for patients in 30-minute one-to-one sessions with either one or three weekly sessions, depending on the high- or low-intensity over a course of 5 months. These interventions consisted of joint musical activities which included singing or instrumental play. The goal of the activities was to enhance sharing and joint attention in ASD which are linked to the development of social abilities. The methods that were used were based on the child’s focus of attention, and the use of improvisation techniques. At the end of the five months of intervention, the authors didn’t find much social changes over time or differences between music therapy and standard care. However, there were a few limitations that may have prevented from accurate results. It was mentioned that music therapy was not implemented consistently also the duration of intervention and follow up were not long enough. Usually, music therapy is continued for years and not months, this could time frame could have been too short to see any results in the children. Another limitation I observed was that the study treated individuals from nine different countries. Some resources or approaches may differ from one country to another, with the varying amount of technology, some interventions in certain countries may not be of great quality and lead to inaccurate results. Also, the musical methods that were mentioned didn’t seem as effective as the approaches other studies used in their music interventions. There were more imitating activities or music that related to the child’s emotions which correlated to increase in social abilities. The type of treatment given to a child is very crucial for effective results in social skills, this is something that was lacking in this study.

Conclusions and Directions for Future Research

Encouraging results are shown within the studies as well as the testing on a more diverse group of individuals that will give more promising results. Identifying effective interventions to increase the improvements of social skills of children with ASD should be a central concern for researchers and specialists. What is experienced in music therapy allows children with ASD to interact with peers, take turns, make eye contact in communication, and thus, lead them to an increasingly positive mood and behavior which will allow them to further excel. Learning through the experience of music will improve their socialization skills and more importantly, language competency. Since there are advanced technologies and a higher understanding of autism, we need to implement treatments that have better and more concrete positive outcomes on those diagnosed with ASD. The use of evidence based practice allows us to choose an effective treatment for our clients. Based on the findings from the studies provided, music therapy is an effective treatment that highly improves social skills within children that have ASD. Even though more research should still be done for optimal results music is still demonstrated as a helpful tool for clients and their abilities in various domains. Future studies by researchers should incorporate bigger groups of children, a wider variety of standardized testing and measurements, and descriptions of the intervention that are more clear and precise. This further reinforces accuracy in the research and clinical application of the results as well as providing a better understanding of the importance of family and child focused approaches involving turn taking and eye contact communication (Vaiouli, 2014). As more research is being made, we will soon recognize music therapy as an established, recognized, and validated treatment because of its vital promotion and increase of social engagement observed in children with ASD. (Crane, 2016).

References

• Adamek, M. S., & Darrow, A. A. (2010). Music therapy services for students with autism spectrum disorders. Music in Special Education. (pp. 207-211). Silver Spring, MD: The American Music Therapy Association.
• Bharathi, G., Venugopal, A., & Vellingiri, B. (2019). Music therapy as a therapeutic tool in improving the social skills of autistic children. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 55(1).
• Bieleninik, L., Geretsegger, M., Mössler, K., Assmus, J., Thompson, G., Gattino, G., … Gold, C. (2017). Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder. Jama, 318(6), 525.
• Carpente, J. A. (2016). Investigating the Effectiveness of a Developmental, Individual Difference, Relationship-Based (DIR) Improvisational Music Therapy Program on Social Communication for Children with Autism Spectrum Disorder. Music Therapy Perspectives.
• Crane, H. (2016). Music therapy and the treatment of children diagnosed with Autism Spectrum Disorder. Lucerna, 10, 110–120.
• Gattino, G. S., Riesgo, R. d. S., Longo, D., Leite, J. C. L. & Faccini, L. S. (2011) Effects of relational music therapy on communication of children with autism: a randomized controlled study. Nordic Journal of Music Therapy, 20, 142–154
• Geretsegger, M., Holck, U. & Gold, C. (2012) Randomised controlled trial of improvisationalmusic therapy’s effectiveness for children with autism spectrum disorders (TIME‐A): study protocol. BMC Pediatrics, 12 (2).
• Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: A randomized controlled study. Journal of Autism and Developmental Disorders, 38(9), 1758–1766.
• Ledford, J. R., King, S., Harbin, E. R., & Zimmerman, K. N. (2018). Antecedent social skills interventions for individuals with ASD: What works, for whom, and under what conditions? Focus on Autism and Other Developmental Disabilities, 33(1), 3–13.
• Lo, Y.-C., Chen, Y.-J., Hsu, Y.-C., Tseng, W.-Y. I., & Gau, S. S.-F. (2016). Reduced tract integrity of the model for social communication is a neural substrate of social communication deficits in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 58(5), 576–585.
• Mössler, K., Gold, C., Aßmus, J., Schumacher, K., Calvet, C., Reimer, S., … Schmid, W. (2017). The therapeutic relationship as predictor of change in music therapy with young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(7), 2795–2809.
• Oldfield, A., Bell, K. & Pool, J. (2012) Three families and three music therapists: reflections on short term music therapy in child and family psychiatry. Nordic Journal of Music Therapy, 21, 250–261.
• Shi, Z.-M., Lin, G.-H., & Xie, Q. (2016). Effects of music therapy on mood, language, behavior, and social skills in children with autism: A meta-analysis. Chinese Nursing Research, 3(3), 137–141.
• Thompson, G. A., Mcferran, K. S., & Gold, C. (2013). Family-centred music therapy to promote social engagement in young children with severe autism spectrum disorder: a randomized controlled study. Child: Care, Health and Development, 40(6), 840–852.
• Vaiouli, P. (2014). AMTA Student Research Awards – Article Summaries. Music Therapy Perspectives, 32(2), 193.