School of Occupational Therapy

Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

Critically Appraised Topic Project

EVIDENCE TABLE

Name: Kelsey Puliafico and Jennifer Unck

Date: October 8th, 2015
Focus Question: Does music therapy intervention help improve socialization and communication skills in children with autism spectrum
disorders?
Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table:
Inclusion-Articles written in English
-Articles published between 2005-2015
-Participants
-Diagnosis of Autism Spectrum disorder
-Interventions with music therapy
-Intervention outcomes of socialization and communication skills
-Peer reviewed journals
Exclusion-Articles in language other than English
-Articles published before 2005
-Diagnoses other than ASD
-Interventions not utilizing music therapy
-Interventions with outcomes that do not include communication and socialization skills
-Systematic Reviews

Author/
Year

Study
Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

Thompson,
McFerran,
& Gold
(2013)

To determine the
effectiveness of
family-centered,
home-based music
therapy on social
engagement
abilities in children
with severe autismspectrum disorder
(ASD)

Level I
RCT

Intervention:
2 study conditions: in-home
Family-Centered Music
Therapy (FCMT) plus early
intervention (experimental
group) or early intervention
program only (control group).
The control group participants
were monitored so that they
were not participating in any
music therapy groups outside
of the experiment.
Children in the experimental
group received 16 weeks of
FCMT in the home, once per
week for 30-40 minutes, in
addition to early intervention.
Music therapists provided
treatment. Activities focus on
various aspects of social
interaction including shared
attention, focus on faces, turn
taking, response to joint
attention, and initiation of
joint attention

Small sample
size

Clinical and community-based

practice
This type of intervention
program could be
implemented in pediatric
home health services, school
settings, or outpatient
The research supports the use
of music therapy intervention
to promote social engagement
in home and community
settings

23 children with
severe ASD
according to the
DSM-IV-TR, ages 36 years. (4 Female,
19 male). Participants
had limited or no
functional verbal
communication and
attended a familycentered early
intervention
programme.

Outcome Measures:
Primary Outcome Measure:
Vineland SocialEmotional Early
Childhood Scales
(VSEEC)
Secondary Outcome Measure:
The social
Responsiveness Scale
Preschool Version for 3Year-Olds
The MacArthur-Bates
Communicative
Development
Inventories, Words and
Gestures

Effects on social
engagementStatistically
significant effect of
FCMT for the
VSEEC (p< 0.001)
Parents saw
improvement in
social skills in the
home and
community.
Significant
improvement in
childrens
interpersonal
engagement within
FCMT sessions. (p=
0.001).
Effects on speech
and language skillsParent reports gains
in speech and
language in both
groups. No
significant effect was
determined.
Effects on parentchild relationshipParent report
suggests positive
relationship changes
in 3 areas: Perception
of parent-child
relationship,
perception of the
child, and responses
towards the child.

Use of parent
report
Assessments
Parents non
blinded may
cause bias
Use of one
therapist limits
generalizability
of findings.

Program development
Practitioners looking to
implement music intervention
to increase socialization skills
in children with ASD could
use FCMT as a guide for new
program development
Societal Needs
Individuals diagnosed with
ASD oftentimes have
difficulty with
communication and
socialization in the home and
community
Finding effective
interventions to increase
communication and
socialization skills in
individuals with ASD to
reduce stigma and
stereotyping
Healthcare delivery and policy
Due to results of the study,
music therapy should be
considered as an intervention
in conjunction with additional
treatments because small
sample sizes limited the
generalizability of results

The Parent-Child
Relationship Inventory
Child engagement in the
music therapy sessions:
The Music Therapy
Diagnostic Assessment

Education and training of OT

students
Discussion of benefits of
music therapy intervention for
individuals with ASD should
be introduced in entry-level
OT curriculum, however, an
entire course on the subject is
not necessary

Qualitative- Semi-structured
interview

Sandiford,
Mainess, &
Daher
(2012)

Compare the
efficacy of Melodic
Based
Communication
Therapy (MBCT)
to traditional
speech & language
therapy for
eliciting speech in
nonverbal children
with Autism

Level I
RCT
12 nonverbal (<10
words) children with
ASD ages 5-7 (11 M
1 F). Recruitment
from the southern
California local
media/newspaper,
flyers, hospitals, &
universities.

Intervention:
Participants randomly
assigned to one of two
groups: traditional therapy
group or the Melodic Based
Communication Therapy
(MBCT) group. Participants
received four 45 minute
individual intervention
sessions a week over the
course of 5 weeks. To elicit
speech, 25 target words and
25 stimulus items were
selected and were the same
for each treatment group
Outcome Measures:
Criterion referenced
vocabulary test which
was videotaped and
scored by two authors
using the International
Phonetic Alphabet (IPA)

Both groups made

significant progress in
number of verbal
attempts (p<0.001),
number of correct words
(p=0.04), number of
imitative attempts
following treatment
(p=0.01).
MBCT group displayed
more verbal attempts
overall (p=.08)
No significant difference
between treatment groups
in number of correct
words at the end of
treatment.
MBCT group showed
greater overall gains for

Small sample
size
Lack of
follow-up

Refinement, revisions and

enhancement of factual knowledge
or theory
This research supports familycentered intervention for
positive outcomes in children
with ASD
This study has found music to
be a motivating factor for
children with ASD and had
positive effects on parentchild relationships
Clinical and community-based
practice
This study supports the use of
MBCT to improve verbal
communication in children
with ASD as it is a motivating
intervention medium
This intervention approach
could be used in conjunction
with other therapy to be most
effective
Program development
If clients are motivated by
music activities, MBCT
interventions could be
considered to ensure clientcentered treatment
This intervention could be
used to elicit speech in
nonverbal children with
autism or potentially other
diagnoses

Parent survey where

number of words
reported by the parent
prior to and after
treatment were tallied
Imitative attempts were
also tallied and compared
from the first treatment
and the final treatment.

imitative attempts than

traditional group (p=0.03)

Societal Needs
Due to stigma and stereotypes
associated with ASD, these
individuals need to develop
effective communication
skills to interact appropriately
in society and advocate for
themselves
Healthcare delivery and policy
Due to small sample size,
further research is needed to
justify its use as a stand-alone
intervention
Lack of follow-up limits the
ability to determine if the
effects of treatment are long
lasting
This intervention should be
used in conjunction with other
interventions due to its
specificity for speech
production
Education and training of OT
students
Implementing a lecture on the
effects of music therapy on
communication skills for
children with ASD would be
beneficial as the study had
positive results
Due to the specific nature of
the intervention, having a
course on MBCT could be
offered in a standard length
Masters program or OTD
program
Refinement, revisions and
enhancement of factual knowledge
or theory
Research supports the use of
music interventions with
children with ASD and this

LaGasse
(2014)

Measure the effect

of a music therapy
group intervention
on social skills of
children with
Autism Spectrum
Disorder (ASD),
when compared to
typical social skills
training

Level I
RCT
17 children ages 6-9
diagnosed with ASD
(13 M 4 F). Recruited
via word of mouth &
flyers in large
metropolitan area

Intervention:
The participants engaged in a
50 minute intervention
session, twice per week for 5
weeks. The music therapy
group (MTG) was led by a
Board-Certified Music
Therapist and the social skills
group (SSG) was led by
another school educator. The
groups took place in a big
room with video cameras to
record and observe child
interaction skills. Each
session began with a welcome
exercise, and then continued
with a sensory experience,
group interaction, cooperative
play. These exercises were
similar between the two
treatment groups, however,
the social skills group did not
utilize music.
Outcome Measures:
Social Responsiveness
Scale (SRS)
Autism Treatment
Evaluation Checklist
(ATEC)

Significance found for

the interaction of time
and group for SRS scores
(p< .05)
When comparing the
ATEC scores at pretest
over time there was a
significant main effect for
time (p<.01) but no main
effects for the group was
found. There was
significance between
group differences for eye
gaze towards a person
(p<.05), and joint
attention with peers
(p=.031) with the
participants in the MTG
demonstrating higher
means.

Small sample
size
Inconsistency
among parent
report
Objective
measures to
gauge progress
Ranges in
functional and
behavioral
levels between
participants
Low power for
statistical
analysis

research study found

significant results in verbal
attempts with nonverbal
children with ASD
Clinical and community-based
practice
This type of intervention
could be implemented in
school settings or in early
intervention
Music interventions could be
used as a motivating factor to
promote socialization and
play exploration/participation
in children with ASD
Program development
A program could be started
utilizing music therapy to
promote social skills in
children with ASD
The intervention could be
utilized in special education
and should be implemented
by a trained professional
Societal Needs
Due to the importance of
social skills to communicate
ones needs over the lifespan
effective interventions to
improve those skills in
individuals with ASD is
necessary
Without the ability to
communicate effectively,
individuals with ASD are
likely to encounter difficulty
expressing themselves
Healthcare delivery and policy
Results of the study support
the use of music therapy
intervention, however, due to
study limitations further

research is warranted before

policy is written
Education and training of OT
students
More research should be done
on the effects of MTG
intervention with larger
sample sizes and follow-up
prior to implementing it in OT
curriculum
Refinement, revisions and
enhancement of factual knowledge
or theory
This supports the use of more
musical interventions for
social interaction in children
with ASD, however more
research is warranted
Lim (2010)

Explore how the

perception of
organized musical
patterns impact the
perception and
production of
speech in children
with ASD
Examine effect of
music as part of
developmental
speech-language
training for the
children

Level I
RCT
50 participants
between 3 to 5 years,
all diagnosed with
ASD. Recruited from
local treatment
facilities. Prior to the
study measures were
conducted to
determine the childs
level of functioning
(high vs. low) and
their language age

Intervention:
Music treatment (n=18)
administered by a female
music student and it focused
on 36 specific target words. It
incorporated six songs with a
simple song structure and
limited vocabulary. It was a 9
minutes treatment session
done twice a day (morning
and afternoon) for 3 days.
Treatments were videoed.
Speech treatment (n=18) was
administered by the same
female music student and
focused on the same 36 target
words although this was done
by reading stories. Each story
included six target words. The
music student read the stories
to the participants. Pictures
for each target word in the
stories were presented by the
vocalist corresponding to the

Significant effect of
treatment conditions on
verbal production (p
<.001)
Significant effect for
level of function (p
<.001); high level
functioning participants
improved their verbal
production to a greater
degree than participants
with low level
functioning regardless of
training condition
Participants with
echolalia achieved higher
posttest scores than
participants without
echolalia; after evaluating
the two variables of
training condition and
presence of echolalia on
posttest scores, the effect

Duration of the
training videos
Validity of the
VPES

Clinical and community-based

practice:
Results of the study show
both music and speech
therapy are effective
interventions, however, music
therapy was found to be more
effective in lower-functioning
individuals to illicit speech
production
Program development
This intervention could be
implemented by a trained
professional or student
Societal Needs
The range of functional
abilities of individuals with
ASD is vast so it is important
to implement interventions
that are effective across that
range. This study supports
music and speech therapies
for individuals who fall

word. These treatments lasted

5 minutes and 40 seconds.
Control group (n=14)
Outcome Measures:
Level of Function:
Childhood Autism Rating
Scale (CARS)
Autism Diagnostic
Interview Revised
(ADIR)
Pretest/Posttest:
Verbal Production Evaluation
Scale (VPES)

of echolalia on speech
production in children
with ASD approached
significance (p= .055)

various places on the

functional continuum
Healthcare delivery and policy
Further research should be
done to examine specific
effects of music therapy
intervention that may deem it
a more appropriate form of
treatment than traditional
speech therapy

High scores on the VPES

were strongly related to
high language age, high
level of function and
presence of echolalia
Examination of the
relationship between the
effects of training
condition and level of
functioning on change
scores for VPES
indicated an interaction
between training
condition and level of
functioning may exist in
the population as the
statistical result
approached significance
(p=0.53)

Education and training of OT

students
Since the intervention used in
the study was implemented by
a music student, there is
potential to train other
students such as OT students
to utilize the intervention
This intervention could be
covered in OT curriculum
during the discussion of
sensory integration and
autism

Low functioning
participants produced
greater changes in verbal
production after music
training vs. speech; high
functioning participants
saw positive score
changes after both music
and speech training

Gattino, do
Santos

To investigate the
effect of Relational

Level I
Parallel RCT

Intervention:

Independent sample t
tests to determine
relationships between the
training conditions and
various aspects of speech
production; results
indicated no statistically
significant differences
Before the intervention
(T1) and after the

Refinement, revisions and

enhancement of factual knowledge
or theory
This study helps support the
use of different interventions
for low vs. high functioning
individuals with ASD

Small sample
size

Clinical and community-based

practice

Riesgo,
Longo,
Leite, &
Faccini
(2011)

Music Therapy
(RMT) in verbal,
nonverbal, and
social
communication of
children with
autism spectrum
disorders.

24 males ages 7-12

y/o with no previous
treatment with any
music therapy.
Recruited through the
Programme for
Invasive
Developmental
Disorders of the
Hospital de Clinicas
de Porto Alegre

Each child of the

experimental group received
3 music therapy assessment
sessions (30 min per session),
16 weekly interventions of
RMT (30 min of duration), 1
final music therapy
assessment session (30 min of
duration), besides weekly
clinical routine activities.
Participants in the control
group only participated in
weekly routine clinical
activities during this period.
This tool place in the duration
of seven months. It was
conducted by 2 graduate
music therapists. It took place
in the Genetics Services and
Pediatrics Service of HCPA.
Outcome Measures
Primary Outcome Measures:
Childhood Autism Rating
Scale adapted for Brazil
(CARS-BR)
Autism Diagnosis
Interview Revised (ADIR)

intervention (T2), CARSBR scores did not show

any statistical
significance in the 3
measured outcomes.
Participants with autistic
disorder in the
experimental group had a
statistically significant
decrease in scores when
compared with the same
type of participants in the
control group (p=0.008).
The other subgroup
analysis did not show
statistical significance.

Short duration
of intervention
Need more
accurate tools
for outcome
assessment

RMT intervention should not

be implemented as a standalone intervention as there is
not a structured protocol
explaining how to use it
RMT interventions should be
implemented with family
participation to make it most
effective

Program development
Intervention approaches that
utilize family-centered means
could consider the RMT
program in program
development
Societal Needs
Individuals with ASD have
trouble developing effective
relationships with others and
RMT intervention could assist
with improving socialization
and communication skills, but
more research needs to be
done to support it
Healthcare delivery and policy
In order to make the program
more reliable and valid, a
protocol could be written to
ensure the treatment is carried
out the same way each time
Currently RMT has only been
utilized in case studies so it
would be difficult to write a
policy without further
research first
Education and training of OT
students
The study was implemented
by graduate music students
therefore there is potential for
OT students to learn to
implement RMT as well

Kim,
Wigram, &
Gold
(2008)

Determine the
effects of
improvisational
music therapy on
joint attention
behaviors in
preschool aged
children diagnosed
with autism

Level II
Repeated measures
comparison design
10 M between 3 and
5 years old with
autism & no previous
experience in music
therapy or play
therapy

Intervention:
Group 1 (5 participants)
received 12 weekly 30 minute
sessions of improvisational
musical therapy & then 12
weekly 30 minute play
sessions. Group 2 (5
participants) received play
therapy before music therapy.
Treatment sessions were
divided into 15 minutes of
undirected childs play & 15
minutes of therapist directed
play. During the therapy
directed portions, emphasis
placed on modeling & turntaking activities. Predetermined target behaviors
of eye contact & turn-taking
analyzed from DVD video of
selected sessions
Outcome Measures:
Pervasive Developmental
Disorder Behavior InventoryC (PDDBI)
Early Social Communication
Scale (ESCS)

PDDBI correlation
between the mothers &
the professionals
appeared to be very low
ANOVA indicated that
time was significant (p<
0.0001) but other
variables were not
significant
ANOVA suggested
interaction of time and
group was significant
(p=0.01); music therapy
significantly more
effective than play in
addressing joint attention
skills
In eye contact duration a
significant effect
(p<0.0001) was found
when comparing music
therapy condition with
play condition. Eye
contact events occurred
markedly longer in music
therapy.

Small sample
size; results
could not be
generalized to
other
populations

Training classes on
implementing RMT
interventions could be
included in OT curriculum

Refinement, revisions and

enhancement of factual knowledge
or theory
It is difficult to determine
how this study supports
existing theories about
relational skills in individuals
with ASD because it has only
been used in case studies.
More research should be done
to support its effectiveness
Clinical and community-based
practice
Improvisational music
therapy can foster flexibility
and adjustment in daily life
activities for children with
autism

It is a medium for social

motivation in children with
autism as well
It helps facilitate
simultaneous coordination of
listening, visual referencing,
responding, and engaging
Program development
When developing intervention
programs for children with
ASD improvisational music
therapy should be considered
when goals are on joint
attention, as results of the
study show music therapy
was more effective than
traditional play therapy
Societal Needs
It is oftentimes difficult to
find ways to capture the
attention of children with

For turn taking duration,

a significant effect was
found comparing
conditions (p<0.0001)
and session part
(p=0.037). Music therapy
was more effective at
facilitating a longer turntaking duration than the
play condition

ASD and engage them in

communication with others.
Improvisational music
therapy has proven to be
motivating for children with
ASD
Healthcare delivery and policy
If goals are focused on
increasing a childs joint
attention behaviors
improvisational music therapy
would be an effective
intervention
Education and training of OT
students
Although statistical
significance was found for
improvisational music
therapy, due to the small
sample size more research
should be done before
implementing into OT
curriculum
Refinement, revisions and
enhancement of factual knowledge
or theory
This research study supports
the theory that music
interventions are effective at
fostering communication
skills in children with ASD;
specifically in this study
improvisational music therapy
was effective for joint
attention behaviors

Katagiri
(2009)

Examine the effect

of background
music and song
texts on the
emotional
understanding of

Level III
Before and After
design,
counterbalance
treatment order

Intervention:
Four groups were taught the
emotions happiness, sadness,
anger and fear in one of four
treatment order groups. Pretest and post-test measures
were used to determine

Participants made gains

with emotions selected
(fear, anger, sadness, and
happiness) from the preto posttest. Significant
difference in

Small sample
Size
No specific or
valid outcome
measures

Clinical and community-based

practice
Understanding emotions is
important for communication
and the results of this study
show background music helps

children with
autism.

12 students ages 9-15

years old with
primary diagnosis of
ASD who attended
schools in a northern
city of Osaka
Prefecture, Japan.
Recruited from a
weekly community
activity.

understanding of the different

emotions. It employed two
control conditions and two
treatment conditions.
Treatments held in a school
room or at home. They
received 8 individual 30-min.
session 2x a week.
Outcome Measures:
Measures used were not
specified, however the pre
and post-tests assessed
decoding & encoding facial
expressions through four
different subtests:
Recognition of facial
expression from a set of
photographs
Recognition of facial
expression from a set of
schematic drawings
Identification of
situation-based emotions
suggested in a set of
pictures
Facial expression of
emotions by the
participants
Paired t test was used to
determine significance of
pre- and posttest
Repeated Measure
Analysis of Variance was
used to determine if any
one condition was
significant over another

understanding among the

four emotions (p=.01).
Repeated measures
analysis is showed that
there was a significant
difference among the four
subtests (p=.00). No
significant difference
between 1 and 3 and
between 2 and 4 but a
significant difference
between these two pairs
of subtests. Participants
decoding skill for the
emotion fear was the
most improved by the
intervention conditions.

No control
group or
randomization
of participants.
No
experimental
group
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.

children with ASD understand

emotions
Program development
Therapists looking to increase
emotional understanding in
children with ASD should
consider utilizing background
music during interventions
Societal Needs
Children with ASD could
benefit from participating in
interventions utilizing
background music to help
them understand emotions to
increase social interaction
skills
Healthcare delivery and policy
Further research is warranted
in the area of background
music intervention due to the
studys design and small
sample size
Education and training of OT
students
Briefly mentioning the effects
that music has on emotional
understanding in children
with ASD should be
discussed in OT curriculum
Discussion of different types
music to enhance emotional
understanding and sensory
modulation in children with
ASD could be included in OT
curriculum
Refinement, revisions and
enhancement of factual knowledge
or theory
This study supports the use of
music interventions to elicit
appropriate emotional

Lim, &
Draper
(2011)

Compare the
effects of
traditional Applied
Behavior Analysis
Verbal Behavior
(ABA VB) with a
music incorporated
ABA VB approach
for production of
speech in children
with Autism
Spectrum Disorder
(ASD)

Level III
Before and After,
Single group
treatment with 3
training conditions
and 4 verbal operant.
22 children between
3 and 5 years old (17
M, 5 F). All
participants were
verbal or preverbal
with presence of
echolalia and
diagnosis of ASD.

Intervention:
Each participant received
both music and speech
training for a minimum of 3
days a week for two weeks.
The focus of the intervention
was verbal production with
target words for each verbal
operant in each condition.
Within the music condition,
target words were presented
in the form of song lyrics.
Within the speech condition,
other target words were
presented as verbal phrases.

Outcome Measures:
Primary Outcome Measure:
Pre and post-tests were used
to measure target word
production
Verbal Production
Evaluation Scale (VPES)

Both music and speech

training have significant
effects on verbal operant
production. There was a
positive correlation
between the pre
(echolalia) and post
(verbal operant
production) tests
(p=.000).
Music condition was
more effective for echoic
production (p=.039) and
the speech condition was
more effective for tact
production (p=.049)
No significance was
found with the
interactions between pretests and verbal operants
(mand, tact, & echoic),
however there was
significance between the
pre-test and intraverbal
operant (p=.023)

Small sample
size
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

understanding in children
with ASD
This study found music
intervention for teaching
emotions was more effective
than simple verbal instruction

Clinical and community-based

practice
This study shows ABA VB
therapy utilizing a music
condition is beneficial for
production of speech in
children with ASD
ABA VB therapy could be
used for interdisciplinary
treatment, for example with
OT and Speech.
Program development
ABA VB therapy should be
further researched prior to
implementing it into a
structured intervention
program
Societal Needs
Nonverbal children with ASD
have difficulty
communicating their needs
and desires to others
Implementing an intervention
to increase speech production
in nonverbal children with
ASD is important for them to
contribute in society
Healthcare delivery and policy
This intervention approach
should not be used as the sole
intervention
Further research should be
conducted and a more
structured protocol should be
written prior to implementing
ABA VB

Education and training of OT

students
If ABA therapy is discussed
as an intervention approach,
the Verbal Behavior
Approach should be briefly
discussed in a lecture in the
OT curriculum

Kalas
(2012)

To examine the
effect of simple
versus complex
music on the joint
attention of
children with ASD

Level IV
2 x 2 repeated
measures factorial
design
30 children ages 4-6
(28 M 2 F) with
primary diagnosis of
ASD. 15 had
mild/moderate ASD.
15 had severe ASD.
Recruited from early
childhood
intervention
programs in South
Florida.

Intervention:
Each functional group
(mild/moderate & severe
ASD) was divided randomly
into two groups. Half of the
mild/moderate group received
simple music condition
(SMC) for one week, then one
week of no treatment, and a
third week of complex music
condition (CMC). The other
half of the mild/moderate
group received CMC before
SMC. The participants in the
severe ASD group were
randomly divided into these
same interventions.
Outcome Measures:
Primary Outcome Measure:
-Responses to Joint Attention
(RJA)
Early Social
Communication Scales
(ESCS)

Statistical significance
found within the study
indicated that the
mild/moderate ASD
group needed more
stimulation to elicit the
joint attention response,
meaning they did better
with the complex music
treatment (p=.011).
Severe ASD group
needed less stimulation in
order to elicit the joint
attention response,
meaning the simple
music treatment (p=.004).

Small sample
size
Measures used
but they did
not determine
pre or post test
results
They did not
have a no
treatment
group to
compare the
results with
Did not use
any formal
outcome
measure

Refinement, revisions and

enhancement of factual knowledge
or theory
Various techniques for
addressing communication
deficits in children with ASD
have been studied, however
ABA VB therapy utilizing
musical approaches should be
further researched to add to
the existing knowledge base
Clinical and community-based
practice
This study supports the use of
music therapy for eliciting
social skills and joint
attention responses in children
with ASD.
It is necessary to find a
balance in the amount of
sensory stimulation that is
effective for individuals with
ASD
Program development
This studys design limited
the generalizability of results,
therefore, further studies
utilizing randomization of
participants into experimental
and control groups could
potentially produce more
significant results
Therapists should take into
consideration the level of
stimulation that is most

effective for the client when

developing programs
Societal Needs
The ASD diagnosis is
complex ranging from mild to
severe. There is not a specific
protocol describing
intervention that is equally
effective for all individuals
with ASD along the
continuum
Healthcare delivery and policy
Creating an intervention
approach using simple and
complex music tot elicit joint
attention responses should be
individualized and based on
the functional level of the
child with ASD
Education and training of OT
students
Interventions used in this
study could be discussed
during lectures on sensory
integration & modulation
because children with ASD
have varying levels of sensory
deficits
Training in understanding
what types of music will elicit
joint attention responses in
children with mild/moderate
vs. severe ASD could be
included in OT curriculum
Refinement, revisions and
enhancement of factual knowledge
or theory
This study supports the need
for various levels of
stimulation (ex. simple vs.
complex music) in
intervention based on the

functional level of the child

with ASD
Kim,
Wigram, &
Gold
(2009)

To compare the
effects of
improvisational
music therapy
versus toy play
session on the
childrens
responses in
children with ASD.

Level IV
Within-subject
comparison design
10 participants (all
male), ages 3-5 and
with no previous
treatments of music
or play therapy.
Recruited from the
Department of Child
and Adolescent
Psychiatry at Seoul
National University
Hospital.

Intervention:
Children were randomly
assigned to group 1 (music
then play) or group 2 (play
then music). Children
participated in weekly 30
minute sessions for 12 weeks
for each condition. Each
session was divided into an
undirected (child led) part and
a directed (therapist led) part.
Each part lasted 15 minutes.
Target behaviors were then
identified between the 2
groups.
Outcome Measures:
Outcome Measures:
Childhood Autism Rating
Scale (CARS)
PsychoEducational
Profile (PEP)
Vineland Social Maturity
Scale (SMS)
These were all given in the
Korean version.

Secondary Outcome
Measures:
Autism Diagnostic
Observation Schedule
(ADOS)
This was only administered to
4 individuals due to this
measure becoming available
later in the study

Results based on targeted

behaviors.
Joy:
Significance was found
when comparing music
therapy with play therapy
(p <0.001)
Emotional Synchronicity:
Significance was found
when comparing music
therapy with play
(p<0.001)
Initiation of engagement
by the child:
Significance was found
for initiation of
engagement when
comparing the conditions
(p<0.001).
Initiation of interaction
by the therapist:
Significance was found
with the comparison of
music and play (p<0.01),
undirected/directed
comparison (p<0.001). In
both conditions the
directed part reported
higher frequency than the
undirected part.
Compliant response:
Compliant response was
significant when
comparing the two
conditions (p<0.001), and
different sessions
(p<0.05). Overall,
compliant behaviors were
observed more by the

Small sample
size
No control
group
High number
of drop outs.
No pre and
posttest
measurements

Clinical and community-based

practice
This study showed children
with ASD were more engaged
in therapy sessions when it
was more self-directed vs.
therapist-led.
Program development
When developing a program
utilizing improvisational
music therapy children should
be given opportunities to
choose an activity that is
motivating for them
Emotional, motivational and
interpersonal responsiveness
of children with ASD should
be considered when
determining effective
interventions
Societal Needs
More research needs to be
done to determine motivating
interventions for children with
ASD to promote engagement
in society
Healthcare delivery and policy
This intervention should not
be utilized as a stand-alone
intervention however childdirected interventions like
those utilized in the study
should be considered because
they are motivating and
promote engagement in
children with ASD
Education and training of OT
students

children in the music

therapy condition.

No response:
Significance was found
for no response behavior
as well when comparing
the two conditions
(p<0.001). No response
behaviors were seen
twice as much in the toy
play condition than the
music condition.

This study supports the

construct of clientcenteredness in OT practice
Teaching OT students about
implementing music
interventions that are
meaningful to the client and
elicit responsiveness should
be included in OT curriculum

Refinement, revisions and

enhancement of factual knowledge
or theory
Music therapy can help
children with ASD to develop
appropriate emotional and
social skills
The results of this study
suggest that it is important to
allow the child to lead and to
control more of what is
happening during intervention