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Trouble with joint attention is a commonly seen deficit in the early stages of ASD. Because
children with ASD are unable to respond to or initiate joint attention this is seen as one of the
most significant deficits to social interaction (Kalas, 2012). For example, children with ASD may
not initiate conversation or engage in play with peers at school which limits their social
interaction.
Communication difficulties affect a significant number of children with ASD. More specifically,
30-50% of children with ASD never gain useful speech (Pickett et al. 2009). Limited speech
affects a childs ability to effectively communicate their thoughts, feelings and needs to others.
Because children with ASD have these difficulties with communication more interventions need
to be developed to focus on communication and language skills (Lim, 2010).
Research supports a variety of interventions to help improve socialization and communication
skills in children with ASD. Music therapy is one area of research that has been considered and
has provided some effective results. Children with ASD usually need structured guidance for
appropriate interaction (Trevarthen, C., Aitkin, K., Papoudi, D., & Robarts, J., 1996). The
various structures in music, such as rhythms, patterns, and tempo, act as a good medium for
teaching children with ASD about these appropriate skills (Wigram & Gold, 2006). However,
study limitations warrant further research to validate the use of music therapy for ASD.
Summary of Key Findings:
Summary of Levels I, II and III:
Parent perception of childs social interaction skills was positive following music
intervention (LaGasse, 2014, Level I; Thompson, McFerran & Gold, 2013, Level
I)
Individuals with Autism show affinity for music tasks due to increased activation
in specific brain areas related to music (Lim, 2010, Level I; Sandiford, Mainess
& Daher, 2012, Level I)
Music therapy may be an effective tool for speech production and verbalization
in children with ASD ((Lim, 2010, Level I; Sandiford, Mainess & Daher, 2012,
Music therapy helped increase joint attention skills in children with ASD
(LaGasse, 2014, Level I; Kim, Wigram & Gold, 2008, Level II)
All Level I, II and III studies support further research to increase efficacy for
music therapy intervention in children with ASD (Thompson, McFerran & Gold,
2013, Level I; Sandiford, Mainess & Daher, 2012, Level I; LaGasse, 2014, Level
I; Lim, 2010, Level I; Gattino, dos Santon Riesgo, Longo, Leite, & Faccini,
2011, Level I; Kim, Wigram & Gold, 2008, Level II; Katagiri, 2009, Level III;
Lim & Draper, 2011, Level III)
More research with larger sample size and inclusion of control group is needed
to support the use of music intervention in children with ASD (Kalas, 2012,
Level IV; Kim, Wigram & Gold, 2009, Level IV)
Simple music is more effective on joint attention for lower functioning ASD and
complex music is more effective on joint attention for higher functioning (Kalas,
2012, Level IV)
Review Process:
PICO question was developed based on a topic from AOTAs Research Opportunities
Tables- Participation in Performing Arts Programs to Reduce Emotional Problems
Initial PICO question Do children with emotional problems who engage in performing
arts have a reduction in symptoms associated with those emotional problems?
Initial PICO question was too broad for research capacity so it was narrowed down to
Does music therapy intervention help improve socialization and communication skills in
children with autism spectrum disorders?
A comprehensive literature review of the topic was performed using key terms
Articles obtained through the literature review were further examined to determine if they
met inclusion/exclusion criteria
Methodological quality of each article was assessed using the McMaster University
Critical Review Forms - Quantitative Studies
Diagnosis of ASD
Exclusion Criteria:
Interventions with outcomes that do not include communication and socialization skills
Systematic Reviews
Search Strategies:
Categories
Patient/Client Population
Intervention
Outcomes
All appraised articles were peer reviewed and discussed for feedback
Critical reviews and evidence tables were reviewed and approved by course instructor
Results of Search:
Summary of Study Designs of Articles Selected for Appraisal:
Level of
Evidence
I
II
III
Number of Articles
Selected
5
1
2
2
0
0
10
Use of parent report assessments, Parents non blinded may cause bias, Use of
one therapist limits generalizability of findings (Thompson, McFerran, & Gold,
2013)
Short duration of intervention, Need more accurate tools for outcome assessment
(Gattino, do Santos Riesgo, Longo, Leite, & Faccini, 2011)
Level II:
Small sample size; results could not be generalized to other populations (Kim,
Wigram, & Gold, 2008)
Level III:
Small sample size (Katagiri, 2009; Lim, & Draper, 2011)
No specific or valid outcome measures, Diverse ages and verbal abilities, Time
frame for the treatment was too short, No assessment data revealing if they were
able to transfer skills into social interaction in real life (Katagiri, 2009)
Division of the training conditions by the target words rather than by participant
groups, Different formats used for pre and post-tests, It was assumed that there
would be no carryover or period effects between each condition (Lim, & Draper,
2011)
Levels IV and V
Level IV:
Small sample size (Kalas, 2012; Kim, Wigram, & Gold, 2009)
No pre or posttests (Kalas, 2012; Kim, Wigram, & Gold, 2009)
No control group or randomization of participants (Kalas, 2012; Kim, Wigram,
& Gold, 2009)
No formal outcome measure (Kalas, 2012).
High number of dropouts (Kim, Wigram, & Gold, 2009)
No Level V studies appraised
Articles Selected for Appraisal:
Gattino, G. S., dos Santon Riesgo, R., Longo, D., Leite, J. C., & Faccini, L. S. (2011). Effects of
relational music therapy on communication of children with autism: A randomized
controlled study. Nordic Journal of Music Therapy, 20(2), 142-154.
doi:10.1080/08098131.2011.566933
Kalas, A. (2012). Joint attention responses of children with autism spectrum disorder to simple
versus complex music. Journal of Music Therapy, 49 (4), 430-452.doi:
10.1093/jmt/49.4.430
Katagiri, J. (2009). The effect of background music and song texts on the emotional
understanding of children with autism. Journal of Music Therapy, 46 (1), 15-31.
Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint