The Feasibility and Efficacy of Tele-Music Therapy on Children with Autism Spectrum Disorder

The following poster was presented by Yue Wu, PhD, MT-BC at the ACRM 100th Annual Conference in Atlanta, GA on Wednesday, November 1, 2023.

Author Yue Wu standing with her poster presentation at the ACRM 100th Annual Conference in Atlanta, GA on Wednesday, November 1, 2023

Introduction

Low accessibility and lack of resources are primary barriers for children in rural areas to receive music therapy services. This research uses real-time video-conferencing platforms to provide cost-effective music therapy to serve children with autism in any location. The purposes of this concurrent mixed methods research were to understand caregivers’ needs and expectations of tele-music therapy and to test the feasibility and efficacy of tele-music therapy. Qualitative online interviews and a quantitative randomized controlled trial (RCT) were used to collect data to examine two related research questions: What are the caregivers’ needs and expectations of tele-music therapy? What is the feasibility and efficacy of delivering tele-music therapy for children with autism? The specific aims were to:

1. Identify and deliver high-fidelity intervention via tele-music therapy.
2. Examine pre- and post-changes in behavior and cognition resulting from tele-music therapy.
3. Understand the collaboration between the researcher and the parent in goal setting.
4. Understand the barriers and feasibility of delivering tele-music therapy at home.

Methods

Participants:

The targeted populations were children and youth with autism. Forty-three participants, aged between 7 and 17 were recruited to the study. Interventions: The intervention of the study started in February 2021 and completed in May 2022. For each participant, intervention occurred once a week for eight consecutive weeks. Each session is 30 minutes long.

Main Outcome Measures:

1. Goal Attainment Scaling
2. Developmental Behavioral Checklist 2
3. PROMIS® Cognitive Function Parent Proxy Item Bank

Parents of sixteen children with autism were virtually interviewed to learn about community needs and expectations of tele-music therapy. Their children were recruited to participate in an RCT crossover study. Children were randomly assigned to an intervention 1 (n=8) or intervention 2 group (n=8). The treatment plan was developed based on the goal-setting collaboration between participants, their parents, and the researcher. The intervention 1 group received weekly 30-minute tele-music therapy for eight weeks while the intervention 2 group received no intervention. After 8 weeks, the intervention 2 group received the intervention while the intervention 1 group received no intervention. A paired t-test was conducted to compare means between and within groups. Qualitative interviews were conducted to understand how music therapy supports family routines.

The statistical analysis showed that tele-music therapy intervention was associated with increased GAS (+23.7, 95% CI 11.4–35.9, p=0.0009), increased PROMIS® (+4.2, 95% CI 0.2–8.3, p=0.04), and decreased DBC2 though this difference was not statistically significant (-3.5, 95% CI -9.2–2.3, p=0.22). Tele-music therapy intervention was associated with decreased DBC2 Communication Disturbance subscale (-6.1, 95% CI -11.1– -1.2, p=0.02). The statistical results showed that tele-music therapy is an efficacious method to deliver music therapy to children with ASD.

The interviewed parents responded very optimistically to music therapy. The top theme that emerged from the pre-intervention interviews showed that music is a motivation for most children with ASD. They took refuge in music when the outside environment was chaotic or when they had a hard time regulating their bodies. Music also provides a sensory stimulus through sound and vibration. With social communication challenges, music is a safe way for one to express their feelings and connect with family members. Technology worked in favor for many children with ASD as online communication reduced the social interpretation which often is hard for them.

Discussion

Based on the statistics, parents saw the benefits of tele-music therapy, as shown in GAS results. Intervention is a partnership between therapists and caregivers. Previous research has shown the importance of parent involvement in interventions for children with ASD (Azad & Mandell, 2016). Effective communication and collaborative problem-solving between the parents and the interventionists may enhance the outcomes of interventions for children with ASD (Azad, Kim, Marcus, Sheridan, & Mandell, 2016). Parents’ satisfaction toward the treatment has a positive influence on their child's engagement and treatment outcomes (Rey, Plapp, & Simpson, 1999; Acri, Bornheimer, Jessell, Flaherty, & McKay, 2016). Parents' satisfaction may be increased by involving them in the treatment plan development process (Acri, Bornheimer, Jessell, Flaherty, & McKay, 2016).

Recommendations for Future Studies

Clinical reasoning in the field of music therapy does not exist in the literature. Future studies might investigate the clinical reasoning behind therapeutic decision-making to provide guidance for music therapy students and new practitioners. Future studies can investigate the long-term impact of tele-music therapy with a longer dosage (6-month vs. 8-week), or a longitudinal study. The researcher will build upon this project to assess the benefits and challenges of tele-music therapy for children with autism, as well as compare the effectiveness of tele-music therapy to in-person music therapy.

Conclusion

Tele-music therapy as a new service has not been thoroughly investigated. However, the current COVID-19 pandemic has provided a timely opportunity to learn more about the efficacy and challenges of this new way of delivering music therapy services. Both quantitative and qualitative data showed that tele-music therapy is a feasible and potentially efficacious method to deliver music therapy intervention to children with ASD. In future studies, the researcher will build upon this project to assess the benefits and challenges of tele-music therapy for children with autism, as well as compare the effectiveness of tele-music therapy to in-person music therapy. The researcher hopes this clinical research will contribute to the potential for tele-music therapy to be an alternative mode to increase equity and access to music therapy in rural areas worldwide.

Key References

Acri, M., Bornheimer, L., Jessell, L., Flaherty, H., & McKay, M. (2016). The impact of caregiver treatment satisfaction upon child and parent outcomes. Child and Adolescent Mental Health, 21(4), 201-208.

Azad, G., & Mandell, D. S. (2016). Concerns of parents and teachers of children with autism in elementary school. Autism, 20, 435–441.

Azad, G., Kim, M., Marcus, S., Sheridan, S., & Mandell, D. (2016). Parent-teacher communication about children with autism spectrum disorder: An examination of collaborative problem-solving. Psychology in the Schools, 53(10), 1071-1084.

Rey, J. M., Plapp, J. M., & Simpson, P. L. (1999). Parental satisfaction and outcome: A 4-year study in a child and adolescent mental health service. Australian and New Zealand Journal of Psychiatry, 33, 22–28.

Acknowledgment

This study was supported by the University of Minnesota Graduate School Doctoral Dissertation Fellowship