A Cochrane systematic review «Geretsegger M, Fusar-Poli L, Elefant C ym. Music t...»1 reviewed the evidence about the effect of music therapy for autistic people. Results from people receiving music therapy (or music therapy added to standard care) with results from people receiving a similar therapy without music (‘placebo' therapy), standard care or no therapy at all were compared.
Altogether 26 RCTs, quasi-randomised trials and controlled clinical trials with a total number of 1165 participants were included. The studies examined the short- and medium-term effect of music therapy interventions (the mean duration of the intervention 2.5 months, range three days to eight months) for autistic children, youth, and young adults in one-to-one or group settings. Twenty-one studies included children aged from two to 12 years. Five studies included children and adolescents, and/or young adults. Severity levels, language skills, and cognition were widely variable across studies.
Measured immediately post-intervention, music therapy compared with ‘placebo' therapy or standard care was more likely to positively effect global improvement (risk ratio [RR] 1.22, 95% confidence interval [CI] 1.06 to 1.40; 8 studies, 583 participants; moderate-certainty evidence; number needed to treat for an additional beneficial outcome [NNTB] = 11 for low-risk population, 95% CI 6 to 39; NNTB = 6 for high-risk population, 95% CI 3 to 21) and to slightly increase quality of life (SMD 0.28, 95% CI 0.06 to 0.49; 3 RCTs, 340 participants; moderate-certainty evidence, small to medium effect size). In addition, music therapy may result in a large reduction in total autism symptom severity (SMD −0.83, 95% CI −1.41 to −0.24; 9 studies, 575 participants; moderate-certainty evidence). No clear evidence of a difference between music therapy and comparison groups at immediately post-intervention was found for social interaction (SMD 0.26, 95% CI −0.05 to 0.57, 12 studies, 603 participants; low-certainty evidence); non-verbal communication (SMD 0.26, 95% CI −0.03 to 0.55; 7 RCTs, 192 participants; low-certainty evidence); and verbal communication (SMD 0.30, 95% CI −0.18 to 0.78; 8 studies, 276 participants; very low-certainty evidence). Two studies investigated adverse events with one (36 participants) reporting no adverse events; the other study found no differences between music therapy and standard care immediately post-intervention (RR 1.52, 95% CI 0.39 to 5.94; 1 study, 290 participants; moderate-certainty evidence).
Measured in the period of one to five months post-intervention, 1) RR for global improvement between music therapy and comparison groups was 1.19 (95% CI 0.90 to 1.57; P = 0.22; 2 studies, 99 participants; low-certainty evidence), indicating no clear evidence of a difference between music therapy and comparison groups, 2) effect estimates for social interaction (SMD 0.54, 95% CI −0.11 to 1.19, P = 0.10; 2 studies, 59 participants; low-certainty evidence) showed little to no difference between the conditions, and 3) the SMD effect size for verbal communication was small, but the CI ranged from a small to medium harmful to a large beneficial effect (SMD 0.22, 95% CI −0.33 to 0.76, P = 0.44; 1 study, 52 participants; low-certainty evidence), indicating no clear evidence of a difference between music therapy and comparison groups. The average endpoint scores of total autism symptom severity showed a large effect in favour of music therapy measured in the period of one to five months post-intervention (SMD −0.93, 95% CI −1.81 to −0.06, P = 0.04; 2 studies, 69 participants; low-certainty evidence).
Measured in a period of six to 11 months post-intervention, no clear evidence was shown for 1) global improvement (1.14 (95% CI 0.91 to 1.41, P = 0.25; 1 study, 364 participants), 2) social interaction (SMD −0.06, 95% CI −0.30 to 0.18, P = 0.63; 1 study, 258 participants), nor 3) quality of life (SMD 0.04, 95% CI −0.21 to 0.29, P = 0.73; 1 study, 249 participants).
Comments:
The implementations of music therapy were very different from the typical implementation in Finland. The mean duration of the intervention was 2.5 months, range three days to eight months, whereas the minimum duration of music therapy in Finland is one year. Intervention intensiveness ranged from daily to weekly, whereas intensiveness in Finland is mainly weekly. The duration of one session ranged from 10 to 60 minutes, median 30 minutes, whereas one session in Finland lasts principally 45 minutes (even 60 minutes).
Our confidence in the result of the total autism symptom severity decrease and global improvement is low due to unclear blinding of outcome assessments or at high risk of bias at blinding of outcome assessments, and global improvement was defined as binary (improved versus not improved or unknown mainly on a global measure used as primary outcome, but the exact measure was mainly unclear).
Long-term follow-up assessments for music therapy are still lacking.