Journal of Music Therapy. XU (2). 2004.

90-106

© 2004 by the American Music Therapy Association

Music in Intervention for Children

and Adolescents with Autism:

A Meta-Analysis

Jennifer Whipple, MM, MT-BC

The Florida State University

This meta-analysis of 12 dependent variables from 9 quanti-

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tative studies comparing music to no-music conditions dur-
ing treatment of children and adolescents with autism re-
suited in an overall effect size of d = .77 and a mean weighted
correlation of r = .36 (p = .00). Since the confidence interval
did not include O, results were considered to be significant.
All effects were in a positive direction, indicating benefits of
the use of music in intervention. The homogeneity Q value
was not significant (p = .83); therefore, results of included
studies are considered to be homogeneous and explained
by the overall effect size. The significant effect size, com-
bined with the homogeneity of the studies, leads to the con-
clusion that aft music intervention, regardless of purpose or
implementation, has been effective for children and adoles-
cents with autism. Included studies are described in terms of
type of dependent variables measured; theoretical approach;
number of subjects in treatment sessions; participation in
and use, selection, and presentation of music; researcher
discipline; published or unpublished source; and subject
age. Clinical implications as well as recommendations for fu-
ture research are discussed.

According to the National Center on Birth Defects and Develop-

mental Disabilities o f the Centers for Disease Control (n.d.), the in-
cidence o f Autism S p e c t r u m Disorders (ASDs) in the United States
is not known. It is clear, however, that the rate o f diagnosis o f chil-
dren has increased in recent years to the point that more than
15,000 3- through 5-year-old children and 78,000 6- through 21-year-
old students received federally f u n d e d services during the
2000-2001 school year based on a diagnosis o f autism. This does not
include students with ASDs classified by a different category or re-
ceiving regular classroom, private school, or h o m e school education.
 Vol. XLI, No. 2, Summer 2004 91

T h e use of music in assessment of musical and nonmusical skills

has provided insight into individual functioning o f children and
adolescents with ASDs. Based on a qualitative analysis conducted by
Whipple (2003) o f 11 American assessment studies, information
obtained a b o u t musical abilities and preferences as well as o t h e r
auditory discrimination skills and responses support the use of mu-
sic in t r e a t m e n t with this population. In addition, 29 American
studies involving music in treatment were identified, all d e m o n -
strating treatment benefits (Whipple, 2003). Still, additional analy-

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sis may be beneficial in more fully determining the efficacy of mu-
sic in the treatment o f this population.
Meta-analysis is a set of statistical procedures in which quantita-
tive research data are compiled, allowing for greater confidence in
conclusions about the efficacy of treatment and making large bod-
ies of literature more manageable for readers (Johnson, 1989). In
the field o f music therapy, meta-analysis originated with examina-
tion o f music in medical and dental treatment (Standley, 1986),
with multiple updates warranted (Standley, 1992, 1996, 2000) due
to the increasing literature base. In addition, music therapy meta-
analyses have been c o n d u c t e d regarding treatment of d e m e n t i a
(Koger, Chapin, & Brotons, 1999) and premature infant (Standley,
2002), pediatric (Standley & Whipple, 2003), and psychiatric popu-
lations (Silverman, 2002). In an endeavor to further examine ben-
efits o f music in intervention, the present rneta-analysis will con-
trast the effects of music and no-music conditions on treatment o f
children and adolescents with autism.
Method
Study Inclusion
Criteria for inclusion in this meta-analysis were studies

1. Using g r o u p or individual subject experimental treatment de-

signs;
2. With design, procedures, and results allowing replicated data
analysis.
3. With subjects who were children or adolescents diagnosed with
autism, eliminating studies incorporating diverse special educa-
tion populations regardless of inclusion of students with ASDs;
4. Utilizing music as a separate, i n d e p e n d e n t variable contrasted
with a n o music control condition;
 92 Journal of Music Therapy

5. With quantitative results reported with sufficient information to

extract an effect size; and
6. In the form o f refereed papers and publications (i.e., theses,
dissertations, j o u r n a l articles, and poster session presentations)
published or presented in the United States.

Based o n accepted meta-analysis process (Johnson, 1989), an ex-

haustive literature search was conducted to find all studies meeting
the defined criteria. Next, characteristics and qualities of the col-

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lected studies were identified, described, and coded. Finally, each
study's results were statistically analyzed and c o n v e r t e d to com-
p u t e d effect sizes using meta-analysis software (Johnson, 1989).
T h e identification o f applicable literature included searches o f
the Journal of Music Therapy (1964-present), Music Therapy Perspec-
tives (1982-84, 1986-present), Music Therapy (1981-96), and Pro-
Quest, the University o f Michigan's on-line database o f disserta-
tions and theses (1950-present), using music and autism or autistic
as keywords. Full papers from all relevant American Music Therapy
Association (AMTA) research poster session presentations from
2002 only were obtained from AMTA. Papers from previous years
were unavailable. Reference lists of all collected published and un-
published papers were searched, as were the music therapy focus is-
sue o f Early Childhood Connections (Humpal, 2001) and an analysis
o f music research with disabled children and youth from 1975 to
1999 (Jellison, 2000).

Study Descriptions
O f the 29 t r e a t m e n t studies located, 10 studies met criteria for
inclusion in the meta-analysis. An additional study met the criteria
(Wylie, 1996), but was eliminated prior to data analysis as it was the
only study involving children with the ASD o f Rett's Disorder,
rather than strictly children with autism. Consequently, the result-
ing meta-analysis focused exclusively on t r e a t m e n t for individuals
with autism, not ASDs. T h e studies meeting criteria are m a r k e d
with an asterisk in the reference section and are described in Table
1 in terms o f type o f d e p e n d e n t variables measured; theoretical ap-
proach; n u m b e r of subjects in treatment sessions; participation in
and use, selection, and presentation o f music; researcher disci-
pline; published or unpublished source; and subject age. G e n d e r is
not listed since all studies had all or mostly male subjects. This is to
VoL XLI, No. 2, Summer 2004 93

be expected since the rate of autism is four to five times higher in

males than females (APA, 2000). O f the included studies, the earli-
est was published in 1976 and 50% were conducted by music ther-
apists. Regarding type o f d e p e n d e n t variables measured, social be-
haviors were considered to include those such as self-stimulation
and attention to task. C o m m u n i c a t i o n variables included inci-
dences of vocalization, speech, sign, and eye contact. The category
of cognitive skill included academic tasks, vocabulary acquisition,
and following directions for motor tasks. Included studies are sum-

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marized below.

In the category of social behaviors, Brownell (2002) and Pasiali

(2002) explored the use of social stories set to music to reduce
challenging behaviors. Clauss (1994) examined the effect of
background instrumental music on the self-stimulatory behaviors
of adolescents when engaged in a computer task. Wood (1991)
measured the frequency of out-of-seat behaviors during mealtime
of children exposed to background instrumental music.
In the c o m m u n i c a t i o n category, Watson (1979) explored the
use of a token e c o n o m y system in which tokens received for
spontaneous speech were exchanged for participation in a mu-
sic therapy session. T h r e e studies measured overall commu-
nicative acts of children: Wood (1991), when exposed to back-
g r o u n d instrumental music during mealtime; O ' L o u g h l i n
(2000), when exposed to language-based songs; and Wimpory,
Chadwick, and Nash (1995), when provided with several music
therapy sessions incorporating games, movement, singing, and
musical a c c o m p a n i m e n t of activities.
In the category of cognitive skills, Carroll (1983) examined the
effect o f sung versus spoken instruction on the ability of chil-
dren to follow instructions to complete a gross motor task. Sim-
ilarly, Laird (1997) assessed the effect of sung versus spoken in-
structions on direction following and accuracy of geometric
shape identification by children and adolescents. Clauss (1994)
measured the response accuracy o f adolescents in completing a
c o m p u t e r task when exposed to background instrumental mu-
sic. In the only included study utilizing a standardized assess-
ment, Litchman (1976) used the Peabody Picture Vocabulary
Test to measure the vocabulary acquisition of children and
adolescents in background music and no-music conditions.
TABLE 1 ¢.O
Study Descriptors--Part A
Studyattthors&year Variableanalyzed Typeofvariable Subjectage Discipline Theoretical
approach Session
Brownell (2002) challenging behaviors Social Behavior 6-9 y Music Therapy DSP htdividual
Carroll (1983) gross motor task Cognitive Skill 4-9 y Education DT-TB Individual
completion
Clauss (1994) computer task response Cognitive Skill 13-21 y Psychology CABA Individual
accuracy
Clauss (1994) self-stimulatory behaviors Social Behavior 13-21 y Psychology CABA Individual
Laird (1997) shape identification Cognitive Skill 3-20 y Music Therapy DT-TB Individual
M = 9.62 y
Litchman vocabulary comprehension Cognitive Skill 5 y, 5 m-20 y, 5 m; Education DT-TB Individual
(1976) M = 11 y, 2 m & Psychology
O'Loughlin point & look at sdmtdus Cognitive Skill 3-10 y; Education CABA Individual
(2OOO) M=4y, 10m
O'Loughlin eye contact & verbalization Communication 3-10 y; Education CABA Individual
(2OOO) M=4y, 10m
Pasiali (2002) challenging behaviors Social Behavior 7-9 y; M= 8 y Music Therapy DSP Individual
Watson (1979) spontaneous speech Communication 7-16 y d from http://jmt.oxfordjournals.org/ at University of Sussex on August 31, 2014 Music Therapy DT-TB Group
Wimpory et al. social acknowledgment, Communication 3 y, 3 m Music Therapy DSP Individual
(1995) eye contact, & initiation
Wood (1991) mealtime out-of-seat Social Behavior 2.5-12 y; Occupational DSP Group
behaviors M = 8.46 Therapy
Wood (1991) eye contact & Communication 2.5-12 y; M= 8.46 Occupational DSP Group
communicative acts Therapy
TABLE 1
Part B

Music Music Publication

Studyvariable Musicuse Musicselection presentation involvement source
o3
Browneli social stories set to music melody of "You Are My Sunshine" Live Active Published
Carroll sung instructions original compositions Live Active Unpublished
Clauss background piano music (60 & 120 bpm) Recorded Passive Unpublished
(Cognitive)
Clauss (Social) background piano music (60 & 120 bpm) Recorded Passive Unpublished
Laird sung instructions original composition Live Active Unpublished
Litchman background instrumental children's music Recorded Passive Unpublished
O'Loughlin picture identification language-based songs Recorded Acdve Unpublished
(Cognitive) & direction following
O'Lougblin picture identification language-based songs Recorded Active Unpublished
(Communication) & direction following
Pasiali social stories set to music child preferred melodies rom http://jmt.oxfordjournals.org/ at University of Sussex on August 31, 2014 Live Active Unpublished
Watson music therapy session rhythm instruments, Live Active Published
as reinforcement movement, & songs
Wimpory et al. structure games, movement, singing, & Live Active Published
musical accompaniment of activities
Wood (Social) background Baroque & Hemi-sync music Recorded Passive Unpublished
Wood background Baroque & Hemi-sync music Recorded Passive Unpublished
(Communication)
Note. y = year. m = month.

tO
96 Journal of Music Therapy

O'Loughlin (2000) measured the ability of children to accurately

look at and point to stimuli when provided with language-based
songs, promoting picture identification and direction following.

Eighteen additional articles involving music in the treatment of

children and adolescents with autism were evaluated and determined
not to meet study inclusion criteria based on the following factors:

1. Studies with insufficient data points for analysis (Brescia, 1982;

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Goldstein, 1964; Griggs-Drane & Wheeler, 1997; Hadsell & Cole-
man, 1988; Mahlberg, 1973; Miller & Toca, 1979; O'Connell,
1974; Saperston, 1973; Staum & Flowers, 1984);
2. Studies without a no-music control condition (Buday, 1995;
Edgerton, 1993, 1994; Gore, 2002a, b; Stevens & Clark, 1969);
3. Studies in which the music condition could not be separated
from another intervention (Chilcote-Doper, 1982; Hairston,
1990; O'Dell, 1998) ;
4. Study in which the music and no-music condition data could
not be separated (Rao, 2001);
5. A study in which music intervention was a constant factor, with
different nonmusic reinforcement interventions (Schmidt,
Franklin, & Edwards, 1976).

In some cases, studies could have been eliminated for more than
one factor, though only the primary factor is cited. One study
(Chilcote-Doper, 1982) eliminated for inability to separate music
from other variables, also could have been eliminated since a
recorded drumbeat was the only form of auditory stimulation in-
cluded in the study. For this meta-analysis, the incorporation of
both pitch and rhythm were required in order for the auditory
stimulation to be considered music. In another study (Buday,
1995), eliminated for lack of a clear control condition, used vocab-
ulary signed and spoken in the rhythm of children's songs, elimi-
nating only the melodic element, for the nonmusic condition.
Consequendy, this operational definition of music may be impor-
tant in future analyses. Finally, five articles describing treatment
techniques for children and adolescents with ASDs were not in-
cluded in this analysis as they did not include quantitative data
(Furman, 2001; Hollander & Juhrs, 1974; Nelson, Anderson, &
Gonzales, 1984; Thaut, 1980, 1984; Toigo, 1982).
 VoL XLI, No. 2, Summer 2004 97

Data Extraction
When selecting variables for analysis, the following hierarchy was
employed:

• the single variable with quantitative data was recorded;

• if m o r e than o n e variable was available, the p r i m a r y variable
based on the title of the study or otherwise identified focus of
intervention was selected;

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• if several variables m e t that criterion and all were of the same
type of data (e.g., frequency of behavioral observations) and in
the same category of variable m e a s u r e d (i.e., social behavior,
c o m m u n i c a t i o n , or cognitive skill), the data were c o m b i n e d
into one variable;
• when it was not possible to select o n e variable or c o m b i n e mul-
tiple variables into o n e measure, the two most i m p o r t a n t vari-
ables based on the already identified focus of the study were se-
lected, with a limit of two variables set for each study to avoid
disproportional weighting of studies.

This process resulted in selection o f 13 variables f r o m 10 studies.

When multiple baseline conditions were r e p o r t e d and conditions
in addition to the extractable music conditions were included in
the original study, data f r o m the baseline condition immediately
p r i o r to the music condition, rather than a m e a n o f the baseline
conditions, was used for this meta-analysis in o r d e r to avoid pollu-
tion from the o t h e r nonmusic condition. Variables were converted
to an estimated effect size, C o h e n ' s d, using meta-anaiytic statistical
software ( J o h n s o n , 1989).

Results
Listed in Table 2 are the sample size, 95% c o n f i d e n c e interval,
and Pearson r and C o h e n ' s d statistics with their probability for
each selected study variable. Effect sizes ranged f r o m .09 to 3.36
with an overall effect size o f d = .83 and a m e a n weighted correla-
tion of r = .38 (p = .00). Since the confidence interval did not in-
clude 0, results were considered to be significant. All effects were in
a positive direction, indicating benefits o f the use o f music in in-
tervention with this population. In addition, the h o m o g e n e i t y Q
value was not significant (p = .39), allowing results o f studies to be
considered consistent and e x p l a i n e d by the overall effect size.
 98 Joumal of Music Therapy

TABLE 2

Study N d 95% C| r p

Brownell 4 .67 -0.75 ± 2.10 .42 .26

Carroll 6 .38 -0.76 ± 1.75 .22 .47
Clauss (Cognitive) 5 .09 -1.15 ± 1.33 .05 .88
Clauss (Social) 5 .29 -0.96 ± 1.54 .18 .60
Laird 13 .79 -0.01 ± 1.59 .39 .04
Litchman 20 1.71 +0.68 ± 2.73 .67 .00

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O'Laughlin 11 .82 -0.05 + 1.69 .40 .05
(Cognitive)
O'Loughlin 11 .63 -0.22 ± 1.49 .32 .13
(Communication)
Pasiali 3 .52 -1.10 + 2.15 .42 .35
Watson 10 1.19 +0.24 ± 2.14 .54 .01
Wimpory et al.* 1 3.36 +1.33 ± 5.40 .88 .00
Wood (Social) 4 .95 -0.51 ± 2.41 .55 .13
Wood 4 .42 -0.98 ± 1.82 .28 .47
(Communication)
Note. * This study was the largest outlier and is not included in overall analysis results
below.
Overall: .77 +0.46 ± 1.08 .36 .00
N= 9 studies, 12 variables.
Q (11) = 6.656; p= .8262.
Total N = 76 subjects in studies, 96 subjects by variables.
Mean N/study 8.44. Mean N/variable = 8.00.

H o w e v e r , t h e l a r g e s t o u t l i e r was W i m p o r y e t al. ( 1 9 9 5 ) , with a n ef-

f e c t size ( d = 3.36) a l m o s t two s t a n d a r d d e v i a t i o n s l a r g e r t h a n t h e
n e x t h i g h e s t e f f e c t size f o r L i t c h m a n (1976) ( d = 1.71). S i n c e W i m -
p o r y e t al. (1995) was t h e o n l y s t u d y i n c l u d e d with a s a m p l e size o f
o n e a n d was t h e l a r g e s t o u t l i e r , it was m a r k e d f o r e x c l u s i o n f r o m
d a t a analysis.
D a t a r e a n a l y s i s w i t h o u t W i m p o r y e t al. (1995) r e s u l t e d in a n
o v e r a l l e f f e c t size o f d = .77 a n d a m e a n w e i g h t e d c o r r e l a t i o n o f r =
.36 (p = .00). S i n c e t h e c o n f i d e n c e i n t e r v a l d i d n o t i n c l u d e 0, re-
sults w e r e c o n s i d e r e d to b e s i g n i f i c a n t . A g a i n , all e f f e c t s w e r e in a
p o s i t i v e d i r e c t i o n , r a n g i n g f r o m d = .09 to d = 1.71, i n d i c a t i n g b e n -
efits o f t h e u s e o f m u s i c in i n t e r v e n t i o n w i t h this p o p u l a t i o n . T h e
n e w h o m o g e n e i t y Q v a l u e was e v e n less s i g n i f i c a n t (p = .83), t h e r e -
fore, r e s u l t s o f i n c l u d e d s t u d i e s a r e c o n s i d e r e d to b e h o m o g e n e o u s
a n d e x p l a i n e d by t h e o v e r a l l e f f e c t size.
 VoL XLI, No. 2, Summer 2004 99

Clinical Implications and Research Recommendations

Meta-analysis o f research regarding children and adolescents
with autism reveals that all use of music in treatment with this
population has a relatively high effect. Benefits are not differenti-
ated based on treatment design, age of subjects, music used, source
o f research, t r e a t m e n t methodology, or profession o f the music
provider.
Prizant, Wetherby, and Rydell (2000) described three theoretical

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approaches to intervention with clients with ASDs: discrete trial-
traditional behavioral (DT-TB), developmental social-pragmatic
(DSP), and c o n t e m p o r a r y applied behavioral analysis (CABA).
T h e first, DT-TB was most p r o m i n e n t in the 1960s and 1970s. In-
tervention did n o t occur in natural environments based on the
t h e o r y that clients with autism were unable to learn in a natural
context due to their learning deficits and the limited quantity o f
trials and r e i n f o r c e m e n t available within daily routines. Emphasis
was on teaching speech communication and m o t o r behaviors re-
lated to activities o f daily living. All elements were taught through
repetitive trials massed in sets o f approximately 100, though cur-
rent practice supports sets of approximately 10 trials per session.
An individual trial included presentation o f the stimulus by-the
therapist or teacher; client response; consequence o f verbal or pri-
mary r e i n f o r c e m e n t (e.g., food) or of verbal or physical punish-
ment followed by physical prompting of the correct response; and
a pause before beginning the next trial with presentation of the
next stimulus. Over time, the use of physical p u n i s h m e n t was
largely eliminated from research and clinical practice. Research
and clinical applications of DT-TB techniques were first to indicate
the ability of individuals with autism to learn communication and
appropriate social skills, but often behaviors did not generalize to
other environments and were incompatible with spontaneous and
initiated c o m m u n i c a t i o n (Prizant et al., 2000).
T h e DSP m o d e l is at the other end o f the theoretical approach
continuum. This model developed in the late 1970s and 1980s and
focused on i n t e r v e n t i o n within the context o f daily routines and
events. Avoiding exclusive p r o m p t i n g and shaping o f responses,
teachers, therapists, and family members were to respond to the
child's communicative attempts within the context o f social inter-
action. The DSP approach emphasizes creation o f motivating con-
texts, routines, and activities; following the child's lead; analyzing
 1O0 Journal of Music Therapy

children's unconventional and early communicative behaviors for

meaning; assisting emotional regulation and expression; establish-
ing individual goals based on current communicative abilities and
learning strengths; and focusing on meaningful language and
functional communication instead o f building larger repertoires o f
speech and language lacking context and c o m p r e h e n s i o n (Prizant
et al., 2000).
In between the DT-TB and DSP approaches is CABA, which be-
gan in the 1990s and incorporates the behavioral concepts of rein-

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f o r c e m e n t for a p p r o p r i a t e responses, yet structures intervention
for generalization o f skills. In contrast to a DT-TB approach, CABA
allows either client-led or combined therapist- and client-led inter-
actions to e n c o u r a g e communication initiation, emphasizes activi-
ties p r e f e r r e d or selected by the child, and relies on natural and
minimally structured interactions. Like DSP, the aim o f CABA in-
t e r v e n t i o n is to facilitate spontaneous c o m m u n i c a t i o n and social
interaction across settings and situations. Still, definite differences
are a p p a r e n t between CABA and DSP methods. T h e CABA ap-
proach focuses less consistently than DSP on the typical language
d e v e l o p m e n t sequence, focuses m o r e on m e a s u r e m e n t of behav-
ioral responses than holistic successful participation, looks at isolated
behaviors more frequently than targeting multiple goals within one
experience, and places less emphasis on development o f relation-
ships and social and emotional expression (Prizant et al., 2000).
In analysis o f music intervention with this population based on
theoretical approach, Whipple (2003) f o u n d that the p r e p o n d e r -
ance o f studies most closely fit the DSP approach, though most
studies c o n t a i n e d elements o f m o r e than o n e theoretical ap-
proach, Still, studies were d e t e r m i n e d to be from one a p p r o a c h
based on a p r e p o n d e r a n c e of the above defined characteristics
within each individual study. Greatest emphasis was placed on the
c o n t e x t in which t r e a t m e n t occurred, functionality o f goals, and
evidence o f general!zation. Based on categorization d e t e r m i n e d in
Whipple (2003), studies included in this meta-analysis were spread
a m o n g the three approaches, with four DT-TB, four CABA, and
four DSP. Based on the nonsignificant h o m o g e n e i t y Q value, re-
sults of this meta-analysis showed no difference in treatment effect,
whether theoretical approach was DT-TB, CABA, or DSP. This is of
importance since c u r r e n t national research trends support DSP re-
 Vol. XLI, No. 2, Summer 2004 101

search focused on functional and spontaneous communication, so-

cialization, play skills, generalization and maintenance, natural
contexts, positive approaches to address problem behaviors, and
functional academic skills (National Research Council, 2001;
Prizant et al., 2000).
The most obvious need revealed by the met,a-analysis process is
for studies with quantitative data and nonconfounding research de-
signs, as evidenced by the reduction from 29 identified treatment
studies to only 9 meeting criteria for this meta-analysis. O f those

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eliminated, nine were on the basis of insufficient data points for
analysis. T h e elimination of others without no-contact control or
exclusive music conditions was necessary for the purpose o f this
meta-analysis, but may not necessarily represent a gap in the re-
search base in the same way as do those without adequate quanti-
tative data.
Additionally, studies with larger sample sizes are needed. Several
of the studies excluded on the basis of insufficient data were case
studies. Others included were in the form of case studies but with
data p r e s e n t e d in such a way that they could be considered as a
group o f subjects with a c o m m o n measured variable (Brownell,
2002; Pasiali, 2002). T h e largest samples were f o u n d in Litchman
(1976) with a between groups design of 10 subjects per group, to-
taling 20 subjects, and Laird (1997) with a within subjects design of
13 subjects, each serving as their own control. The total sample size
for the meta-analysis was 76 from the 9 studies included, resulting
in a m e a n sample per study o f 8.44. When calculated for the 12
study variables included, the sample size rises to 96, but the mean
sample decreases to 8.00 per study variable. This is an extremely
small sample size in quantitative research.
Many studies also appear to be in the form of post hoc analysis o f
clinical work. This limits the inclusion of these studies in meta-
analysis, as they may have insufficient or no pre-treatment baseline
data. Also, music t r e a t m e n t data may not be able to be extracted
from o t h e r intervention variables. In addition, while not necessar-
ily precluding their inclusion in meta-analysis, these studies often
have small sample sizes and present difficulty in selecting primary
variables to analyze due to global assessment approaches.
The body of literature regarding music in intervention with chil-
dren and adolescents with autism reports the following benefits:
 102 Joumal of Music Therapy

• increased appropriate social behaviors and decreased inappro-

priate, stereotypical, and self-stimulatory behaviors;
• increased attention to task;
• increased vocalizations, verbalizations, gestures, and vocabulary
comprehension;
• increased echolalia, moving toward increased communication,
and decreased echolalic percentage of total utterances;
• increased communicative acts and engagement with others;
• e n h a n c e d body awareness and coordination;

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• improved self-care skills and symbolic play;
• anxiety reduction.

However, since the meta-analydc process required that many stud-

ies be excluded, only music uses found in Table 1 were supported
in the c u r r e n t study. Additionally , treatment and program descrip-
tions without quantitative data advocate the use of Orff-Schulwerk
techniques ( H o l l a n d e r &Juhrs, 1974) in addressing a multitude o f
non-musical therapeutic goals. Also suggested without data support
is learning to sing or play an instrument to provide long-term ben-
efits for quality of life, self-esteem, and social acceptance (Nelson et
al., 1984; Toigo, 1992). Several suggestions regarding the use o f
music in teaching academic material have also been made, often
based on music therapy treatment and research with broad special
education populations, but n e e d further clarification o f the effi-
cacy o f specific techniques for this unique population (Furman,
2001; Nelson et al., 1984; Thaut, 1980, 1984; Toigo, 1992).
T h e National Research Council (NRC) (2001) has stressed the
n e e d for integration o f the diverse bodies o f literature related to
ASDs, encompassing differences based on experimental design, in-
cluding single-subject and group experimental, as well as differ-
ences based o n focus, to include neurological, behavioral, and de-
velopmental aspects. Only two of the 9 studies included in final
analysis, and three of the 10 originally analyzed studies, were from
published sources. Based on the NRC recommendations and to al-
low for better access to information, the greatest n e e d at this point
in time appears to be for more published studies regarding the use
of music in intervention with this population.
Most i m p o r t a n t for music therapists is to be cognizant that all
music intervention has been effective for children and adolescents
with autism. Music appears to be so powerful a tool with this popu-
 VoL XLI, No. 2, Summer 2004 103

l a t i o n t h a t r e g a r d l e s s o f its p u r p o s e o r h o w it is u s e d f o r a p a r t i c u -
lar c l i e n t , it a c h i e v e s p o s i t i v e effects. H o w e v e r , m u s i c t h e r a p i s t s
h a v e n o t d i f f e r e n t i a t e d t h e i r p r o f e s s i o n a l r o l e with this p o p u l a t i o n .
T h e g o a l o f f u t u r e r e s e a r c h , w h i l e a d d r e s s i n g t h e s a m p l e size a n d
d e s i g n clarity d e f i c i t s a l r e a d y d e s c r i b e d , s h o u l d be to assess t h e ef-
ficacy o f s p e c i f i c a p p l i c a t i o n s o f m u s i c in t h e t r e a t m e n t o f c h i l d r e n
and adolescents with autism.

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