Music therapy for autistic spectrum disorder

 

Abstract

Background

The central impairments of people with autistic spectrum disorder (ASD) include social interaction and communication. Music therapy uses music and its elements to enable communication and expression, thus attempting to address some of the core problems of people with ASD.

Objectives

To review the effects of music therapy for individuals with autistic spectrum disorders.

Search methods

The following databases were searched: CENTRAL, 2005, (Issue 3); Medline, (1966 to July 2004); Embase, (1980 to July 2004); LILACS, (1982 to July 2004); PsycINFO, (1872 to July 2004); CINAHL, (1982 to July 2004); ERIC, (1966 to July 2004); ASSIA, (1987 to July 2004); Sociofile, (1963 to July 2004); Dissertation Abstracts International, (late 1960's to July 2004). These searches were supplemented by searching specific sources for music therapy literature and manual searches of reference lists. Personal contacts to some investigators were made.

Selection criteria

All randomised controlled trials or controlled clinical trials comparing music therapy or music therapy added to standard care to "placebo" therapy, no treatment or standard care.

Data collection and analysis

Studies were independently selected, quality assessed and data extracted by two authors. Continuous outcomes were synthesised using a standardised mean difference (SMD) in order to enable a meta-analysis combining different scales, and to facilitate the interpretation of effect sizes. Heterogeneity was assessed using the I² statistic.

Main results

Three small studies were included (total n = 24). These examined the short-term effect of brief music therapy interventions (daily sessions over one week) for autistic children. Music therapy was superior to "placebo" therapy with respect to verbal and gestural communicative skills (verbal: 2 RCTs, n = 20, SMD 0.36 CI 0.15 to 0.57; gestural: 2 RCTs, n = 20, SMD 0.50 CI 0.22 to 0.79). Effects on behavioural problems were not significant.

Authors' conclusions

The included studies were of limited applicability to clinical practice. However, the findings indicate that music therapy may help children with autistic spectrum disorder to improve their communicative skills. More research is needed to examine whether the effects of music therapy are enduring, and to investigate the effects of music therapy in typical clinical practice.

 

Plain language summary

Music therapy for people with autistic spectrum disorder

People with autism spectrum disorders (ASD) have difficulties with communication, behaviour and/or social interaction. Music therapy uses music and its elements to enable people to communicate and to express their feelings. In this way music therapy addresses some of the core problems of people with ASD. This review set out to assess the evidence for the effectiveness of music therapy for individuals with ASD.

Three small studies were included which examined the short-term effect of brief music therapy interventions for autistic children. Music therapy was superior to "placebo" therapy with respect to verbal and gestural communicative skills, but it was uncertain whether there was an effect on behavioural outcomes. The included studies were encouraging, but of limited applicability to clinical practice. More research with better design, using larger samples, in more typical clinical settings is needed to strengthen the clinical applicability of the results and to examine how enduring the effects of music therapy are. When applying the results of this review to practice, it is important to note that the application of music therapy requires specialised academic and clinical training.

 

摘要

背景

泛自閉症障礙 (autistic spectrum disorder) 之音樂治療

泛自閉症障礙 (autistic spectrum disorder, ASD) 的患者之主要障礙在社會互動和溝通方面。音樂治療以音樂與其元素來促成溝通以及表達，試圖來解決泛自閉症障礙患者的核心問題。

目標

回顧音樂療法對泛自閉症障礙患者個人的影響。

搜尋策略

我們搜索了以下資料庫：CENTRAL, 2005年 (Issue 3) 、Medline (1966年 to 2004年7月) 、Embase (1980年 to 2004年7月) 、LILACS (1982年 to 2004年7月) 、PsycINFO (1872年 to 2004年7月) 、CINAHL (1982年 to 2004年7月) 、ERIC (1966年 to 2004年7月) 、ASSIA (1987年 to 2004年7月) 、Sociofile (1963年 to 2004年7月) 、Dissertation Abstracts International (1960年代末 to 2004年7月) 。除了上述之搜尋，再補充搜尋音樂治療文獻的特定來源和手工檢索參考資料列表，同時也和一些研究者個人聯繫。

選擇標準

所有以音樂治療或是標準照護加音樂治療來和安慰劑治療、標準照護或沒有任何治療來作比較的隨機對照試驗或對照臨床試驗。

資料收集與分析

由兩名作者分別挑選研究論文、評估品質以及擷取數據。連續性的結果則以標準化平均差 (standardised mean difference, SMD) 表示，以便使不同量表的結果能整合進行統合分析 (metaanalysis) ，同時利於效應值 (effect sizes) 的詮釋。異質性以I2 statistic評估。

主要結論

本篇收納3個小型的研究 (共計包括24位受試者) 。這些研究檢視簡短的音樂治療 (每天一次，持續一週) 對於自閉症的兒童的短期效果。在口語及肢體溝通技能方面，音樂治療優於「安慰劑」治療 (口語方面:2個隨機對照試驗 (RCTs) ，共20位受試者，SMD 0.36 CI 0.15 to 0.57;肢體方面: 2個隨機對照試驗,共20位受試者，SMD 0.50 CI 0.22 to 0.79) 。在行為問題方面，音樂治療和「安慰劑」治療比較，沒有顯著差異。

作者結論

收納的研究在臨床上的應用有限。但是，這個發現顯示音樂治療也許可幫助泛自閉症障礙的兒童提昇溝通技能。未來仍需要更多的研究來檢視音樂治療的效果是否可以持續；同時亦應探索在典型的臨床實務中音樂治療的效果。

翻譯人

本摘要由成功大學附設醫院黃惠群翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

泛自閉症障礙的患者在溝通、行為和/或社交互動上有困難。音樂治療以音樂和其元素來促進患者溝通及表達感受。音樂治療處理了泛自閉症患者的一些核心症狀。此文獻回顧的出發點是要提出音樂治療對泛自閉症患者有效果的證據，共收納了三個檢視簡短音樂治療對自閉症兒童的效果的小型研究。在口語及肢體溝通技能方面，音樂治療優於「安慰劑」治療，在行為問題方面，音樂治療的效果仍不確定。收納的研究結果是正向的，但是臨床應用性有限。未來仍需要設計更周全、樣本數更大、並運用更典型的臨床實境的研究來加強臨床應用性並檢視音樂治療效果的持續性。如果要將本回顧的結果應用在臨床實務時，要注意音樂治療的應用需要經過專門學術臨床的訓練。\