Thursday, 28 December 2017

Music therapy for social skills in autism: RCT says not...

"Adding IMT [improvisational music therapyto the treatment received by children with ASD [autism spectrum disorder] did not improve social affect or parent-assessed social responsiveness."

So said the report published by Crawford and colleagues [1] commenting on recent research [2] observing that IMT might be 'music to the ears' but seemingly not so when it comes to altering symptom severity in the social affect domain of autism.

I'm no expert on IMT in any context so approach this topic with some caution. I remember quite a few years back watching and hearing about sessions where IMT was used as part of a schedule of interventions in the context of autism (see here) and thinking at the time, that it's inclusion seemed like quite a good idea. The data from Bieleninik and colleagues [2] perhaps urge caution that 'sounding good' might not necessarily translate into better outcomes when put under the scientific microscope.

So, 360 or so children diagnosed with ASD were randomised to receive either 'enhanced standard care' (ESC) or ESC + IMT (IMT delivered at high- and low-frequency among this group). I have to say that whilst ESC initially sounded pretty good, I was a little disappointed to hear that it meant "usual care as locally available plus parent counseling to discuss parents' concerns and provide information about ASD." Parent counselling? Remind me what year we're in if this is all we've got under the label of ESC.

After 5 months of ESC and ESC+IMT the scores on the Autism Diagnostic Observation Schedule (ADOS) social affect domain showed... no significant difference between the groups. Even most of the secondary outcomes (17 of 20) showed no significant difference. In short, IMT added to that ESC failed to significantly impact on social affect compared to ESC alone.

An accompanying editorial on the Bieleninik findings [3] talked about the implications of the trial results particularly in light of a previous Cochrane review [4] which suggested that "music therapy may help children with ASD to improve their skills in primary outcome areas that constitute the core of the condition including social interaction, verbal communication, initiating behaviour, and social-emotional reciprocity." The authors urge caution that the previous Cochrane review examined various different types of music therapies for example and whilst coming out on the side of music therapy for autism, determined the scientific quality of available research at that time to be "as either moderate or low quality."

Where next for IMT? Well, I'm going to be a bit more up-beat about this intervention that usual. I say that on the basis that music therapy is probably going to be one of the more 'risk-averse' interventions put forward for autism (first, do no harm and all that). Whilst social affect was not seemingly 'statistically' affected by its inclusion as an intervention option, this does not mean that other facets of autism - whether core or peripheral - might not benefit from its use with some people on the autism spectrum. On this note, I'll refer you to the paper by Pavlicevic and colleagues [5] and the suggestion that "long-term shared therapeutic musicking provides young adults with ongoing opportunities for experiencing confidence and self-esteem, with feelings of shared acceptance and success." Music to the ears eh?

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[1] Crawford MJ. et al. International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study. Health Technol Assess. 2017 Oct;21(59):1-40.

[2] Bieleninik L. et al. Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial. JAMA. 2017 Aug 8;318(6):525-535.

[3] Broder-Fingert S. et al. Music Therapy for Children With Autism Spectrum Disorder. JAMA. 2017; 318(6): 523-524.

[4] Geretsegger M. et al. Music therapy for people with autism spectrum disorder. Cochrane Database Syst Rev. 2014 Jun 17;(6):CD004381.

[5] Pavlicevic M. et al. Making music, making friends: Long-term music therapy with young adults with severe learning disabilities. J Intellect Disabil. 2014 Mar;18(1):5-19.

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