Music Improves Social Communication in Autism Spectrum Disorder – a Randomized Control Trial

Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by pronounced difficulties in social and communication abilities. However, many individuals with ASD demonstrate enhanced perceptual skills, especially in the auditory domain (Heaton, 2009). Based on these and other complementary findings, music therapy has been suggested as a promising approach to improve social communication in ASD (Simpson and Keen, 2011). However, there is currently limited empirical evidence supporting its clinical use (Geretsegger et al, 2014).

Objectives: The present study aims to evaluate the effects of a music-based intervention on language and social communication in children with ASD, compared to a non-music control intervention using a randomized control trial design.

Methods:  Fifty children aged 6-12 years with a diagnosis of ASD participated in a single-blind, parallel-arm randomized control trial of music therapy that is currently ongoing (ISRCTN26821793). Here, we report data from 18 children who have completed the trial. Participants were randomly assigned to 12 weekly sessions of individual music (MT, n=9) or non-music (NM, n=9) control therapy. Music therapy sessions involved use of songs and rhythmic cues to improve turn-taking and reciprocal social interactions as well as communication. The non-music control therapy targeted similar skills but without the use of music. Both groups were matched on age, sex, IQ and socioeconomic status. Participants underwent extensive behavioral assessment before (T1) and after therapy (T2). Primary outcome measures at both time points included receptive vocabulary using the Peabody Picture Vocabulary Test (PPVT), social skills using the Social Responsiveness Scale (SRS-2), and communication using the Children's Communication Checklist (CCC-2). Data were analysed using repeated measures ANOVA.

Results: Compared to NM, a larger proportion of children in the MT group showed an improvement over 12 weeks in social communication. Specifically, 75% of MT had improved CCC-2 scores at T2 compared to 44% of NM (Figure 1). Overall PPVT and SRS-2 scores showed no significant differences between the groups over time (p>.05). However, there was a trend for an interaction between group and time point for CCC-2 in the direction of improvement for MT (p=.087). Trends of improvement in MT at T2 compared to NM were observed on the CCC-2 subscales Interests (p=.061), Initiation (p=.077), and Nonverbal Communication (p=.094). Additionally, both groups showed significant improvement on the CCC-2 subscale Social Relations (p=.023). A trend towards improvement on the SRS-2 subscales Social Cognition (p=.062) and Social Communication (p=.089) was also observed for both groups (Figure 2).

Conclusions: These findings suggest that music therapy may lead to specific improvements in social communication in ASD, in particular in terms of interests, initiation, and nonverbal communication compared to non-music interventions. Additionally, music therapy demonstrated equivalent improvement in social relations, social cognition and social communication compared to the non-music therapy. Results from this preliminary analysis provide support for the use of music as a therapeutic tool for children with ASD. This work will provide insight into both behavioural and neural mechanisms mediating response to music-based interventions in children with ASD.