The effect of music therapy sessions on the interactions between children and their parents and how to measure it, with reference to attachment theory.

Music therapy and attachment is an expanding field and the number of studies addressing the theoretical work is slowly growing. There are both qualitative and quantitative approaches to studying the effect of regular music therapy sessions on parent-child interactions and these cover a range of patient populations including: children at risk of neglect, parents with a trauma history, children coping with bereavement and a large number addressing the disability population, including autism spectrum disorder. These studies suggest that music therapy benefits the parent-child relationship through the improvement communication, especially non-verbal communication, and so increased the feeling of closeness and understanding. Following a review of the available literature, a pilot study is described using transcripts of video recordings of music therapy sessions, and subsequent colour coding and conversion of the data into pie charts provides a potential method of analysis that produces an "interaction profile" of each parent-child dyad. Preliminary results of this method of analysis suggest that music therapy sessions might be able to improve interactions through therapists addressing the power dynamics within a relationship. The new method developed in this pilot study to visualise and study the parent-child relationship in music therapy sessions was effective and could be used and developed by music therapy researchers in the future.

Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial.

Importance: Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. Objective: To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. Design, Setting, and Participants: Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. Interventions: Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents' concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child's focus of attention, to help children develop affect sharing and joint attention. Main Outcomes and Measures: The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. Results: Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, -0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference. Conclusions and Relevance: Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder. Trial Registration: isrctn.org Identifier: ISRCTN78923965.