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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering

Randomised controlled Trial of Improvisational Music therapy's Effectiveness for children with Autism spectrum disorders (TIME-A)

Awarded: NOK 15.4 mill.

The TIME-A project (2012-2016) aims at investigating the effects of improvisational music therapy in children with autism spectrum disorder (ASD). In 2014, TIME-A researchers published a Cochrane systematic review which provided evidence that music therapy can improve some core problems of children with autism, such as social communication and interaction skills, as well as social adaption skills and the quality of relationships with parents. Building onto these findings, TIME-A will provide more specific and more reliable evidence of improvisational music therapy (IMT) as applied internationally today. Long-term effects, relational qualities of IMT, and dose-effect relations have not received enough attention in previous research but are of central interest in TIME-A. More than 300 children with ASD from nine countries worldwide have been recruited and randomised. This is more than in the ten previous studies together and more than in most other studies of interventions for ASD. It shows that IMT is of high interest and feasible across a range of settings and cultures. Including many participants is important to achieve reliable estimates of effects. The developed network between music therapists, other professions, clinical and research institutions has provided an important basis for successful recruitment. In 2015, TIME-A researchers published a new guideline describing in detail the most important principles of IMT, based on an international consensus. This guideline does not aim to provide a complete manual or even replace the basic training of music therapists; rather, it provides a means for raising the competence level of already qualified music therapists. IMT principles are described as child-centered and relational. They emphasise the child?s individual process by giving therapists a guiding focus, but without restricting them too much. This is crucial when working with relational qualities of musical interactions that need to be child-, process-, and context-related. The guideline will help music therapists to work consistently across countries and settings. Results from a treatment fidelity analysis have already shown that different therapists can relate and adhere to the IMT principles. In addition to examining IMT?s effects and describing IMT principles in detail, the project also aims to examine more closely the mechanisms of change (i.e., what makes the therapy effective). TIME-A researchers have developed and applied various assessment tools to look at developmental steps in autism on a musical and relational level. After successful reliability tests, they are now ready for use in projects related to TIME-A. One project examining mechanisms of change, the ?Shared Moments? project, has received additional funding from the Research Council and will re-use the data from TIME-A to go beyond the objectives of TIME-A to further understand how and when IMT works. This will also have the potential to predict who can benefit most from IMT, an issue that is important to improve planning and policy-making. The project is now closed, but publications are still in review. Results are summarised in the Results Report.

Background: Previous research has suggested that music therapy may facilitate skills in areas typically affected by autism spectrum disorders (ASD), such as social interaction and communication. However, generalisability of previous findings has been rest ricted, as studies were limited in either methodological accuracy or the clinical relevance of their approach. The aim of this study is to determine effects of improvisational music therapy on social communication skills of children with ASD. Additional a ims are to examine if variation in dose of treatment (i.e., number of music therapy sessions per week) affects outcome of therapy, and to determine cost-effectiveness. Methods: Children aged 4;0 to 6;11 years diagnosed with ASD will be randomly assigned t o one of three conditions. Parents of all participants will receive three sessions of parent counselling (at 0, 2, and 5 months). In addition, children randomised to the two intervention groups will be offered individual, improvisational music therapy ove r a period of five months, either one (low-intensity) or three (high-intensity) sessions per week. Generalised effects of music therapy will be measured using standardised scales completed by blinded assessors (Autism Diagnostic Observation Schedule, ADOS ) and parents (Social Responsiveness Scale, SRS) before and 2, 5, and 12 months after randomisation. Cost-effectiveness will be calculated as man years. A group sequential design with first interim look at usable N = 235 (randomised N = 300) will ensure s ufficient power for a small to medium effect as well as efficiency. Conclusions: Responding to the need for more rigorously designed trials examining the effectiveness of music therapy in ASD, this pragmatic trial sets out to generate findings that will b e well generalisable to clinical practice. Addressing the issue of dose variation, this study's results will also provide information on the relevance of session frequency for therapy outcome.

Funding scheme:

BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering