The use of music therapy for a variety of disorders, including Autism Spectrum Disorders (ASD), has been recognized by the professional healthcare disciplines as a therapeutic stimulus that succeeds in accomplishing treatment goals that are not musical per se. There is a great deal of research that links speech with singing, rhythm and motor behavior, and memory for song as well as memory for academic material, and overall ability of preferred music; this enhances mood, attention, and behavior, and all of these methods are used to optimize a student's ability to learn and interact. As a result, one of the goals of music therapy for people with autism disorders is to help the individual with a beginning assist that uses strategies involving melodies and rhythms, and which is followed by diminishing of the musical cues in order to help in generalization and transfer to other settings. There has been a great deal of research that reinforces the value of this therapy with the ASD population; nevertheless, the soundness of this research has been questioned, several studies of which will be explored and evaluated.
When music therapy is used for people with autism, as with other disorders, it is incorporated into a treatment plan that is developed by educators, nurses, doctors, and other healthcare professionals while being delivered in accordance with practice standards. There are various outcomes that are sought, and these include an increase in attention; behavioral improvements; a decrease in self stimulating behaviors; enhancements in auditory processing; improved cognitive functioning; decreases in agitation; an increase in socialization skills and behaviors; improvement in verbal skills; the ability to engage in successful and safe self-expression; and improvement in sensory motor skills.
There is a great deal of literature involving research into the impact of music therapy on adults and children with autism spectrum disorder. The first large meta-analysis of the wide field of using music therapy for children and adolescents with any psychopathology was published in 2004, and indicated that in general, music therapy has a moderate to significant impact on this population. However, one of the weaknesses of this early compilation of research was that only one of the studies specifically addressed Autism Spectrum Disorder. Since then, there have been two systematic reviews that were specifically concentrated on ASD, and there were uneven and contradictory results contained in the research.
Whipple's study involved a collection of research of any design that explored the impact of music interventions, either background music or music therapy, compared with no music on results such as challenging behaviors and social interaction. The research, which included individuals with autism ranging from 2.5 to 21 years of age, in samples that varied from 1 to 20, indicated that there was substantial and homogeneous overall effect of music therapy on individuals, which suggested that the conditions associated with music were more effective than those without music. However, one of the difficulties about this research was that the music used was so heterogeneous that it was nearly impossible to draw legitimate conclusions on the effects of music therapy. In addition, significant design features that were used including randomization and blinding, were not readily transparent.
Another systematic review of the impact of music therapy on ASD was conducted by Ball, comparing the impact of music therapy in contrast with no such treatment on outcomes including behavior, communication, and social interaction in children with ASD. Three different studies were included in the research, involving randomized controlled trials, controlled clinical trials, and case series that included at least 10 participants. The results of the studies indicated that although there were substantial effects of music therapy, the actual impacts were not clear. As a result of the lack of compelling evidence linking the impact of music therapy on children and adults with ASD, it became clear that more research needed to be done to substantiate the link. This ultimately became the focus of research conducted by Wigram and Gold, who were able to examine the vast body of research on the topic and draw conclusions about the actual effect of music therapy on people with ASD.
The tremendous literature review conducted by Wigram and Gold put them in the position of being able to examine past research studies and their limitations, and to conduct their own research that allowed them to draw definitive conclusions about the connection. They concluded that music therapy intervention offers structure and improvisation that potentially provides a framework for developing learning and adaptability. Further, when a structure such as music therapy is delivered, it is more likely that creative skills will emerge as opposed to what might be expected when an entirely free form of improvisation is offered. The relevance of their conclusions to healthcare providers such as doctors and psychiatric nurses indicates that a lack of structure or direction and modeling may leave a nonmusical child struggling to find out he or she might be able to "create" music.
In any event, whether improvisation is musically structured or free, it seems to provide a complex level of information about ASD worthy of further analysis. It is also crucial for professionals as well as laypeople to remain cognizant that the whole purpose of music therapy is a process that is actually designed to provide happiness and joy, rather than as a therapeutic tool only. On the other hand, using music therapy as a therapeutic intervention is focused on working through complicated problems and gaining insight; therefore, it is important to note that children with Autism Spectrum Disorder exhibit the same challenges when involved in music therapy as they do in all of their other therapeutic interventions, and contained both in the educational environment as well as at home. Presently, research into the area does indicate that there is some evidence of impact when music therapy is used for people with ASD. In addition, in secondary and tertiary diagnostic services, child development centers, and clinical and educational environments where music therapy is included as part of multidisciplinary services, the contribution of this intervention is most obvious in terms of promoting interpersonal communication, reciprocity, and establishing a progressive ability to develop relationship-building skills.
The impact of music therapy on ASD is a very widely studied subject, and is relevant to healthcare professionals because of so much speculation about its positive impact on people with autism. Nevertheless, despite the huge amount of literature on the subject, concrete evidence about the connection is somewhat limited. As described, the various research studies have had certain weaknesses that have made it difficult if not impossible to establish a concrete association between music therapy and benefits to this population. Nonetheless, as Wigram and Gold concluded, the original purpose of music has not been as a therapeutic intervention but rather as an art form that has provided happiness for people of all types, with or without disorders, so that certainly there is no harm in applying music therapy to this, or any, group of people. Clearly, more research must be done to establish definitive benefits of music therapy for people with ASD regarding behavior, self-regulation, interpersonal skills, and communication skills, among others. Healthcare professionals are in the best possible position to provide help to people with ASD when they are armed with concrete data about what therapeutic interventions may produce the most tangible results.
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