International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background:
Preliminary studies have indicated that music therapy may benefit children with autism
spectrum disorders (ASD).
Objectives:
To examine the effects of improvisational music therapy (IMT) on social affect and
responsiveness of children with ASD.
Design:
International, multicentre, three-arm, single-masked randomised controlled trial, including a
National Institute for Health Research (NIHR)-funded centre that recruited in London and the east of
England. Randomisation was via a remote service using permuted blocks, stratified by study site.
Setting:
Schools and private, voluntary and state-funded health-care services.
Participants:
Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent or
guardian who provided written informed consent. We excluded children with serious sensory disorder and
those who had received music therapy within the past 12 months.
Interventions:
All parents and children received enhanced standard care (ESC), which involved three
60-minute sessions of advice and support in addition to treatment as usual. In addition, they were
randomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESC
alone, over 5 months in a ratio of 1 : 1 : 2.
Main outcome measures:
The primary outcome was measured using the social affect score derived from
the Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment.
Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and
12 months (higher scores indicated greater impairment).
Results:
A total of 364 participants were randomised between 2011 and 2015. A total of 182 children were
allocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocated
to ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) in
the intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171
(94.0%) received it. From baseline to 5 months, mean scores of ADOS social affect decreased from 14.1 to
13.3 in music therapy and from 13.5 to 12.4 in standard care [mean difference: music therapy vs. standard
care
=
0.06, 95% confidence interval (CI)
–
0.70 to 0.81], with no significant difference in improvement.
There were also no differences in the parent-rated social responsiveness score, which decreased from 96.0 to
89.2 in the music therapy group and from 96.1 to 93.3 in the standard care group over this period (mean
difference: music therapy vs. standard care
=
–
3.32, 95% CI
–
7.56 to 0.91). There were seven admissions to
hospital that were unrelated to the study interventions in the two IMT arms compared with 10 unrelated
admissions in the ESC group.
Conclusions:
Adding IMT to the treatment received by children with ASD did not improve social affect or
parent-assessed social responsiveness.
Future work:
Other methods for delivering music-focused interventions for children with ASD should
be explored.
Preliminary studies have indicated that music therapy may benefit children with autism
spectrum disorders (ASD).
Objectives:
To examine the effects of improvisational music therapy (IMT) on social affect and
responsiveness of children with ASD.
Design:
International, multicentre, three-arm, single-masked randomised controlled trial, including a
National Institute for Health Research (NIHR)-funded centre that recruited in London and the east of
England. Randomisation was via a remote service using permuted blocks, stratified by study site.
Setting:
Schools and private, voluntary and state-funded health-care services.
Participants:
Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent or
guardian who provided written informed consent. We excluded children with serious sensory disorder and
those who had received music therapy within the past 12 months.
Interventions:
All parents and children received enhanced standard care (ESC), which involved three
60-minute sessions of advice and support in addition to treatment as usual. In addition, they were
randomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESC
alone, over 5 months in a ratio of 1 : 1 : 2.
Main outcome measures:
The primary outcome was measured using the social affect score derived from
the Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment.
Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and
12 months (higher scores indicated greater impairment).
Results:
A total of 364 participants were randomised between 2011 and 2015. A total of 182 children were
allocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocated
to ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) in
the intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171
(94.0%) received it. From baseline to 5 months, mean scores of ADOS social affect decreased from 14.1 to
13.3 in music therapy and from 13.5 to 12.4 in standard care [mean difference: music therapy vs. standard
care
=
0.06, 95% confidence interval (CI)
–
0.70 to 0.81], with no significant difference in improvement.
There were also no differences in the parent-rated social responsiveness score, which decreased from 96.0 to
89.2 in the music therapy group and from 96.1 to 93.3 in the standard care group over this period (mean
difference: music therapy vs. standard care
=
–
3.32, 95% CI
–
7.56 to 0.91). There were seven admissions to
hospital that were unrelated to the study interventions in the two IMT arms compared with 10 unrelated
admissions in the ESC group.
Conclusions:
Adding IMT to the treatment received by children with ASD did not improve social affect or
parent-assessed social responsiveness.
Future work:
Other methods for delivering music-focused interventions for children with ASD should
be explored.
Date Issued
2017-10-01
Date Acceptance
2017-08-01
Citation
HEALTH TECHNOLOGY ASSESSMENT, 2017, 21 (59), pp.1-+
ISSN
1366-5278
Publisher
NIHR JOURNALS LIBRARY
Start Page
1
End Page
+
Journal / Book Title
HEALTH TECHNOLOGY ASSESSMENT
Volume
21
Issue
59
Copyright Statement
© Queen’s Printer and Controller of HMSO 2017. This work was produced by Crawford et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and
study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement
is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be
addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre,
Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement
is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be
addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre,
Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Sponsor
National Institute for Health Research
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000413416300001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
12/167/95
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
PERVASIVE DEVELOPMENTAL DISORDERS
SOCIAL COMMUNICATION BEHAVIORS
DIAGNOSTIC INTERVIEW
JOINT ATTENTION
YOUNG-CHILDREN
INDIVIDUALS
AGE
1117 Public Health And Health Services
0807 Library And Information Studies
0806 Information Systems
Health Policy & Services
Publication Status
Published