Music for ASD patients

Autistic Spectrum Disorder

In the past recent years, the number of people diagnosed with autism has been increasing and Autism has been branched out into various terms. The American Diagnostic and Statistical Manual (DSM) is a manual assembled by the American Psychiatric Association that defines and classify mental illnesses so that more accurate diagnoses and treatments can be provided to patients. According to DSM-5, the term Autism Spectrum Disorder (ASD) includes patients suffering from Autistic disorder, Asperger disorder, Pervasive Developmental Disorder (PDD) in which ASD can be defined as persistent difficulties in communicating and interaction with the society and whereby their behaviors, interests or even activities are in a limited context and tend to be monotonous (“Profiles and criteria – National Autistic Society”, 2018). Patients suffering from ASD are usually finding themselves in this permanent state for their whole lifespan. However, due to the improvement of the society in this modern era, extensive researches have allowed the condition of ASD patients to be significantly improved. According to the NHS (2018), ASD can be improved by providing to the patients with language and speech therapy, occupational therapy and support in education. The most significant example would be that by using music the engagement of the patient and therapist in a musical-emotional interaction. Music has been used as a platform by therapists to provide behavioural communication and social engagement with patients suffering from autism (Alvin & Warwick 1992). Hence, the focus on this research will be facilitated on how music contributes to the health and wellbeing of ASD patients. Furthermore, the article will also address on the different uses of music that enables the improvement of ASD patients’ condition and finally, the effects of utilizing music that are beneficial for ASD patients.

What is Autistic Spectrum Disorder and how will music help

The integration of music and its contribution to health presented in this section reflects the significance of music to the development of condition in ASD patients. According to WHO (2018), a healthy state refers to the ‘completeness of physical, mental and social well-being and not merely the absence of disease or infirmity’. This perspective suggests that every individual can use their own resources to eliminate the state of illness without the need of being reliant to external support (e.g., people, machine, therapy) on overcoming health difficulties. On the contrary, autism is considered present in the state of a child if he/she persist of severe and pervasive impairments in reciprocal social interaction and communication, language disability, narrow and rigid behavior patterns as well as mental retardation (Zander, 2004). This neurodevelopment disorder causes ASD patients to deviate in behavioral norms where the ways they process and interpret information are different to of normal individuals. For instance, Al Shirian & Al Dera (2015) claim that autistic symptoms include: difficulty in having eye contact, repetition in verbal language and action, mimicry of the others, not responding when their names are called, defect in joint attention, and limitations with nonverbal communication (Seif Eldin et al., 2008). The difference between normal individuals and ASD patients is that ASD patients possess deficiency in communication and behaviour hence external assistance is required for the cause of improving their condition.

For this reason, music has been used as an instrument to facilitate the communicative behaviors and social engagement with autism patients (Alvin & Warwick 1992). A study by Blackstock (1978) has reported that ASD patients tend to show a preference for auditory stimuli over other stimuli when music is used as the primary purpose of stimulating their auditory experience (Kolko et al. 1980). Furthermore, Thaut (1988) proclaimed that ASD patients’ engagement with auditory stimuli usually last longer in duration as compared to similar developing children on the same stage of development. He also used a group of children suffering from ASD to measure their music improvisational skills and discovered that there is no significant difference in rhythm, restriction and originality compared to chronologically age matched peers, in which supports the integral element of musical responsiveness in this group. Subsequently, with ASD patients showing no rejection to the usage of music in this context, in a therapeutical context, music can be used to aid their physical and emotional health. For this reason, music therapy has been used to stimulate and provide positive changes to ASD patients. It refers to the methodical development of intervention where therapist use musical interactions, experience and the relationships intertwining to help patients improve their conditions (Bruscia, 2005). Subsequently showing that the inducement of music into the development of ASD patients is significantly essential.

Music can enhance cohesiveness in groups.

The significance of group cohesion in music has been demonstrated by Roederer (1984) in his study of music perception. He suggests that music can transmit emotional information to various participant at the same moment, where the groups’ emotional state is of the same level, thus resulting in a bonding effect between the group members. Sloboda (1985) posited that all cultures require the cognitive and social organization of practices and mental methods for existence, and that while modern cultures have ‘various complex artefacts that help us to express and represent the organizations we need and value’ (Sloboda 1985), in other non-literate societies the ‘organizational structures’ must be evidenced and articulated primarily in terms of the communicative behaviours that people interact with one another. For example, music can provide an informative framework for the knowledge of a specific group, and also express the relevant structure of social relations (Cross & Morley, 2010). This perception suggests that, ASD patients through music is able to notice their similar peers and hence group together in the community.

Music as an essential tool of simple understanding

Music is a form natural sounds that can be easily perceived in the subconscious of the brain. A recent meta-analysis of in the study of neuroscientific in music perception by Janata and Grafton (2003) proves that passive musical perception appears to involve associate areas of the brain with motor functions of human, when evoked by the auditory arrangements of music, mirroring aspects of physical movement (Scherer & Zentner, 2001). Music can be simply understood, not as abstract patterns of sound expected in motionlessness, but as a meticulously embodied activity of human agents (Cross & Morley, 2010). For example, ASD patients do not need to study how music ‘operates’. They simple understand simple forms of music and subsequently perform simple gestures such as tapping their foot automatically when listening to music.

Music entrainment and neurology perception

The majority of contexts where music is involved are not only active but also participatory, it involves the explicit and active engagement of participants in musical group activities. The fundamental element of this participation is ‘entrainment’ where Clayton, Sager & Will (2004) suggested this as the timing arrangements of one participant’s musical behaviours with the others. This process seems to include the involvement of the innate or cognitive alignments of the timing of actions and resonances surrounding the motivating pulse where the perceptual implication or abstraction of a consistent periodic pulse or beat from a sequence of rhythmic events. Subsequently, it emphasises attention prospectively to the time points where pulse is present, with an associated periodic modulation of the amount of attentional resources set specifically to tracking the temporal flow of the music, again orientating around the pulse (Drake et al. 2000). Pulse abstraction enables the optimum usage of attentional resources over a period of time according to cognitive interpretation. In relation to this, study shows that events occurring in temporal alignment with the inferred pulse are detected and identified more easily than events that occur out of phase with the pulse (Jones and Yee 1993). According to Thaut (2005) in a neurophysiology context, the experience of pulse seems closely linked to the various ranges of timing in the coordination of gross and fine movements. Entrainment to an external pulse may be either volitional (under conscious control) or preconscious (Stephan, Thaut, & Wunderlich., 2002). Hence, it can be suggested that the musical interactions between human participants is based on natural intuition in which mind-generated progressions of pulse abstraction/generation is within the different participants. The perceptual processes are vital to the prospective temporal control of periodic motor behaviour. Music serving as the medium of interactive social behaviour subsequently provides the means for coordinating the arrangement of a participant’s experience of moving with that of other participants, thus facilitating the participants and their joint (intersubjective) focus on certain moments and sequential patterns in the temporal unfolding of the music.

Music for ASD patients

Geretsegger, Elefant, Mossler & Gold (2014) in their study, music therapy for people with spectrum disorder, reported that music intervention for ASD patients contain positive effects on their on emotional engagement, social interaction and communicative skills. ASD patients are significantly capable of processing music (Kanner, 1943). In Molnar-Szakacs & Heaton’s (2012) study, they show that ASD patients show integral and essential musical skills such as absolute pitch, improved melodic memory and processing of pitch contours (Ouimet, Foster, Tryfon & Hyde, 2012). This perception suggests that the ASD patients can accept the auditory characteristics of music and respond to the musical inducements where it has been shown that ASD patients demonstrate intact emotional responsiveness to music (Caria, Venuti & de Falco, 2011). Music serves as a functioning instrument that mediates the neural networks to interact with each other. In discovering new behavioral and neuroimaging studies, Molnar-Szakacs & Heaton in (2012) stated that the dissociation between ability to recognize music in domains of musicality and sociality in ASD patients provide us the prospect of looking into the nature of processing emotional difficulties depicting this disorder. For instance, if the relationship between music and patients can be derived, it may generate new ways to decrease the suffering of them on an extensive scale. Additionally, engagement with music will also change how the brain reacts and promote extensive changes. Even the simplest yet explicit form of music interaction can allow the brain to reorganize itself and therefore form new neural connections based on the understandings of each different individual (Schlaug, Altenmüller and Thaut, 2010. Neuroimaging studies have shown that engaging in musical activities will activate the multimodal network of the brain regions, which includes hearing, movement, emotion, pleasure and memory (Wollman, Penhune, Segado, Carpentier & Zatorre, 2018). This allows transfer of musical therapeutic effects to non-musical areas (Stegemoller, 2014) through structural and functional changes in the brain (Habibi et al., 2017).

Music therapy is vital in bringing beneficial effects to ASD patients

Music therapy is an instrument that can evoke emotional, behavioral and motivational responses of ASD patients. This has been thoroughly utilised in the study of music therapy to stimulate ‘interpersonal relatedness’ in which has been suggested by Shahar, Henrich, Blatt, Ryan & Little (2003) as the need to establish intimate, stable, protective, and fostering relationships. For this reason, Holck’s (2007) study in microanalysis in music therapy suggests that with the intervention of therapy, music therapist identifies the following music features: progressive beat, melodic contour, patterns in rhythm, expression dynamics) in the child’s behaviour (musical and non-musical) subsequently forming an emphatic and supportive musical structure to appeal and engage with the patient. His study further demonstrated that this can happen in non-verbal and multimodal contexts, which includes vocal and instrumental exchanges, eye contact, facial expressions, movement and gestures (Wigram, 2002). The use of a sustainable and methodical intervention allows music therapists to seek and establish an expressive relationship with ASD patients through a joint process of music making where Alvin and Warwick (1992) suggested this as clinical improvisation. Clinical improvisation refers to the usage of impromptu musical composition in which takes into account of emotional communication, instrumental technique and the spontaneous response in the environment where trust and support is established to meet the needs of patients (Wigram, 2004). Wigram (2004) further suggested that within this certain framework, patients can create their own music and they concurrently reflect some characteristics of their inner-selves (moods, feelings, attitudes).

Music therapy invites a child to listen, sing, move and play instruments, at which when they are involved in music, the interaction of senses, emotions, and cognition creates a dynamical system where the body, the mind, and the surroundings interact (Kölsch 2009). This further helps explain why shared interactions in music can improve emotional empathy, social skills and bonding in ASD patients (Schellenberg, Corrigall, Dys & Malti, 2015). Additionally, the positive influence of music in enhancing social abilities has been demonstrated in patients suffering from ASD (Särkämö, Tervaniemi & Huotilainen, 2013). Kirschner & Tomasello (2010) claimed that the performance of patients in a developing stage, are greatly enhanced when they interact with each other following a shared musical experience. For example, a music therapist can use simple musical patterns such as strumming of a guitar to initiate patients’ participation. Musical activities and engagement in music therapy can become ‘organized, synchronized, and structured through form (harmony, melody), intensity (dynamic), and coherences in timing (e.g. metre, rhythm) within a child (intra-subjective) and between the child and the therapist (inter-subjective)’ (Schumacher and Calvet 2008). Musical activities in a therapeutic context allows the development of behavioural changes in ASD patients (LaGasse, 2017). In this context, patients can perceive and understand better the therapist’s music as the music has been arranged for simpler comprehension which may motivate them to respond, join in, and initiate subsequent musical interaction with the therapist (Robarts, 1996). Hence, music therapy plays a central role in enhancing the conditions of ASD patients.

Effects of uses of music therapy to ASD patients

Music therapy has shown evident results in proving that music is significant in its therapeutical value. Kim, Wigram & Gold (2009), in discovered the effects of music therapy on emotion, social and motivation of children with autism. In their study, 25 children aging from 3 to 5 with no experience in music therapy was chosen. The study lasted for 12 weeks with music therapy provided to the children 30 minutes every week. Results show that music therapy is able to induce ‘joy’ and there were significant emotional synchronicity events in which the children’s spontaneous level of interaction with others were very high.

Children with autism often have difficulty in expressing and communicating their emotions at the right moment and place in a social environment. This perception is suggested by Newson (1984) stating that autism children tend to face difficulties in social timing.

Another study was held by Sharda et al., (2018) to explore how music intervention can improve the social communication and auditory-motor connectivity in ASD patients. 51 children aged between 6 to 12 with autism and were randomized to receive music intervention for 8 to 12 weeks in which 26 children were provided with music intervention while 25 children were not. Again, the trial demonstrated that 8 to 12 weeks of intervention can certainly change the brain connectivity and enhance social communication and behavioural movements. The improvements were evidently significant as the children that receive music intervention show clear and specific to pragmatics (able to deal with language in use), decrease of inappropriate initiations and greater social relations and interests.

Autistic Spectrum Disorder (ASD) is a disability where patients find it hard to interact and express their emotions normally in a general context. Various research have been explored in the recent years to explore the relationship between music and how it can improve the conditions of ASD patients. When the significance of music is put into consideration of ASD patient’s development, it can be seen that therapy plays a crucial role in connecting with ASD patients. Once they receive therapeutical assistance, music therapy’s importance can be shown by theories of support and social learning. However, further evidence for the effectiveness of music therapy is limited as there is no neuroscientific basis for its use in ASD. Given the impact of music on social functioning and brain connectivity, alongside atypicality in these areas in ASD, music-based activities has been prove to be able to restore altered brain cognition and finally, future research should focus on better understanding of the neural mechanisms underlying music-related changes in the brain connectivity in ASD patients.

Reference list

Al Shirian, S., & Al Dera, H. (2015). Descriptive characteristics of children with autism at Autism Treatment Center, KSA. Physiology & Behavior, 151, 604-608. doi: 10.1016/j.physbeh.2015.09.001

Alvin, J., & Warwick, A. (1992). Music therapy for the autistic child (2nd ed.). Oxford: Oxford University Press.

Blackstock, E. G. (1978). Cerebral asymmetry and the development of early infantile autism. Journal of Autism and Childhood Schizophrenia, 8, 339–353

Bruscia, K. (2005). Standards of Integrity for Qualitative Music Therapy Research. Voices: A World Forum For Music Therapy, 5(3). doi: 10.15845/voices.v5i3.238

Caria, A., Venuti, P., & de Falco, S. (2011). Functional and Dysfunctional Brain Circuits Underlying Emotional Processing of Music in Autism Spectrum Disorders. Cerebral Cortex, 21(12), 2838-2849. doi: 10.1093/cercor/bhr084

Constitution of WHO: principles. (2018). Retrieved from https://www.who.int/about/mission/en/

Cross, I. and Morley, I. (2010). The evolution of music: Theories, definitions and the nature of the evidence. In Malloch, S. & Trevarthen, Colwyn. (Eds.), Communicative Musicality: Exploring the Basis of Human Companionship (pp. 61-81). Oxford University Press.

Geretsegger, M., Elefant, C., Mossler, K., & Gold, C. (2014). Music therapy for people with autism spectrum disorder. Cochrane Database Of Systematic Reviews, 6(6). doi: 10.1002/14651858.CD004381.pub3

Habibi, A., Damasio, A., Ilari, B., Veiga, R., Joshi, A., & Leahy, R. et al. (2017). Childhood Music Training Induces Change in Micro and Macroscopic Brain Structure: Results from a Longitudinal Study. Cerebral Cortex, 28(12), 4336-4347. doi: 10.1093/cercor/bhx286

Holck, U. (2007) ‘An Ethnographic Descriptive Approach to Video Microanalysis’, in T.Wosch & T.Wigram (eds) Microanalysis in Music Therapy. Methods,Techniques and Applications for Clinicians, Researchers, Educators and Students, pp. 29–40. London: Jessica Kingsley

Janata, P. & Grafton, S.T. (2003). Swinging in the brain: Shared neural substrates for behaviors related to sequencing and music. Nature Neuroscience, 6(7), 682–687.

Kanner, L. (1943). Autistic disturbances of affective contact (2nd ed., pp. 217-250). Nerv. Child.

Kirschner, S., & Tomasello, M. (2010). Joint music making promotes prosocial behavior in 4-year-old children. Evolution And Human Behavior, 31(5), 354-364. doi: 10.1016/j.evolhumbehav.2010.04.004

Kolko, D. J., Anderson, L., & Campbell, M. (1980). Sensory preference and overselective responding in autistic children. Journal of Autism and Developmental Disorders, 10, 259–271.

Kölsch, S. (2009). A neuroscientific perspective on music therapy. Annals of the New York Academy of Sciences, 1169, 374–384. doi:10.1111/j.1749-6632.2009.04592.x

LaGasse, B. (2017). Social outcomes in children with autism spectrum disorder: a review of music therapy outcomes. Patient Related Outcome Measures, Volume 8, 23-32. doi: 10.2147/prom.s106267

Lai, G., Pantazatos, S., Schneider, H., & Hirsch, J. (2012). Neural systems for speech and song in autism. Brain, 135(3), 961-975. doi: 10.1093/brain/awr335

Molnar-Szakacs, I., & Heaton, P. (2012). Music: a unique window into the world of autism. Annals Of The New York Academy Of Sciences, 1252(1), 318-324. doi: 10.1111/j.1749-6632.2012.06465.x

Ouimet, T., Foster, N., Tryfon, A., & Hyde, K. (2012). Auditory-musical processing in autism spectrum disorders: a review of behavioral and brain imaging studies. Annals Of The New York Academy Of Sciences, 1252(1), 325-331. doi: 10.1111/j.1749-6632.2012.06453.x

Robarts, J.Z. (1996) ‘Music Therapy for Autistic Children’, in C.Trevarthen, K. Aitken, D. Papoudi & J.Z. Robarts (eds) Children with Autism: Diagnosis and Interventions to Meet Their Needs, pp.132–60. London: Jessica Kingsley

Roederer, J.G. (1984). The search for a survival value of music. Music Perception, 1, 350–356.

Särkämö, T., Tervaniemi, M., & Huotilainen, M. (2013). Music perception and cognition: development, neural basis, and rehabilitative use of music. Wiley Interdisciplinary Reviews: Cognitive Science, 4(4), 441-451. doi: 10.1002/wcs.1237

Schellenberg, E., Corrigall, K., Dys, S., & Malti, T. (2015). Group Music Training and Children’s Prosocial Skills. PLOS ONE, 10(10), e0141449. doi: 10.1371/journal.pone.0141449

Scherer C and Zentner MR (2001). Emotional effects of music: Production rules. In P Juslin and JA Sloboda, eds, Music and emotion: theory and research, pp. 361–392. Oxford University Press, Oxford.

Schlaug, G., Altenmüller, E., & Thaut, M. (2010). Music Listening and Music Making in the Treatment of Neurological Disorders and Impairments. Music Perception, 27(4), 249-250. doi: 10.1525/mp.2010.27.4.249

Schumacher, K., & Calvet, C. (2008). Synchronization. Music therapy with children on the autistic spectrum. Göttingen: Vandenhoeck & Ruprecht.

Seif Eldin, A., Habib, D., Noufal, A., Farrag, S., Bazaid, K., & Al-Sharbati, M. et al. (2008). Use of M-CHAT for a multinational screening of young children with autism in the Arab countries. International Review Of Psychiatry, 20(3), 281-289. doi: 10.1080/09540260801990324

Shahar, G., Henrich, C., Blatt, S., Ryan, R., & Little, T. (2003). Interpersonal relatedness, self-definition, and their motivational orientation during adolescence: A theorical and empirical integration. Developmental Psychology, 39(3), 470-483. doi: 10.1037/0012-1649.39.3.470

Sharda, M., Midha, R., Malik, S., Mukerji, S., & Singh, N. (2014). Fronto-Temporal Connectivity is Preserved During Sung but Not Spoken Word Listening, Across the Autism Spectrum. Autism Research, 8(2), 174-186. doi: 10.1002/aur.1437

Sloboda, J.A. (1985). The musical mind. Oxford University Press, Oxford.

Stegemoller, E. (2014). Exploring a Neuroplasticity Model of Music Therapy. Journal Of Music Therapy, 51(3), 211-227. doi: 10.1093/jmt/thu023

Thaut, M. (1988). Measuring musical responsiveness in autistic children: A comparative analysis of improvised musical tone sequences of autistic, normal, and mentally retarded individuals. Journal of Autism and Developmental Disorders, 18, 561–571.

Thaut, M. (2005). Rhythm, music, and the brain : scientific foundations and clinical applications. Retrieved from https://ebookcentral.proquest.com

Wigram, T. (2004). Improvisation: Methods and techniques for music therapy clinicians, educators, and students. Jessica Kingsley Publishers.

Wollman, I., Penhune, V., Segado, M., Carpentier, T., & Zatorre, R. (2018). Neural network retuning and neural predictors of learning success associated with cello training. Proceedings Of The National Academy Of Sciences, 115(26), E6056-E6064. doi: 10.1073/pnas.1721414115

Zander, E. (2004). Introduktion om autism. Stockholms Län Sjukvårdsområde.

Clayton, M., Sager, R. & Will, U. (2004). In time with the music: The concept of entrainment and its significance for ethnomusicology. ESEM Counterpoint, 1, 1–82

Drake, C., Jones, M.R., & Baruch, C. (2000). The development of rhythmic attending in auditory sequences: attunement, referent period, focal attending. Cognition, 77, 251–288.

Jones, M.R., & Yee, W. (1993). Attending to auditory events: The role of temporal organization. In S McAdams and E Bigand, eds, Thinking in sound, pp. 69–112. Oxford University Press, Oxford.

Thaut, M.H. (2005). Rhythm, human temporality, and brain function. In D Miell, R MacDonald and D Hargreaves, eds, Musical Communication, pp. 171–191. Oxford University Press, Oxford.

Stephan KM, Thaut MH, Wunderlich G et al. (2002). Conscious and subconscious sensorimotor synchronization – prefrontal cortex and the influence of awareness. NeuroImage, 15, 345–352.

Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13(4), 389-409. doi: 10.1177/1362361309105660

Newson, E. (1984) ‘The Social Development of the Young Autistic Child’, paper presented at the National Autistic Society Conference, Bath, UK.

Sharda, M., Tuerk, C., Chowdhury, R., Jamey, K., Foster, N., & Custo-Blanch, M. et al. (2018). Music improves social communication and auditory–motor connectivity in children with autism. Translational Psychiatry, 8(1). doi: 10.1038/s41398-018-0287-3