Showing posts with label Music therapy. Show all posts
Showing posts with label Music therapy. Show all posts

Tuesday 22 August 2017

Music for Autism? – an acquired taste, apparently

Today’s post is about music and music therapy.

A new study reports that music therapy does not improve autism symptoms.

In an earlier post we saw that singing reduces the level of your stress hormone cortisol; this was based on testing adults in a choir, so not music novices.

Music has actually been shown to do much more than just reduce your level of stress, it can actually affect the expression of your genes, but only in those who are “musically experienced”; in people with little experience of music it does nothing. 

Although brain imaging studies have demonstrated that listening to music alters human brain structure and function, the molecular mechanisms mediating those effects remain unknown. With the advent of genomics and bioinformatics approaches, these effects of music can now be studied in a more detailed fashion. To verify whether listening to classical music has any effect on human transcriptome, we performed genome-wide transcriptional profiling from the peripheral blood of participants after listening to classical music (n = 48), and after a control study without music exposure (n = 15). As musical experience is known to influence the responses to music, we compared the transcriptional responses of musically experienced and inexperienced participants separately with those of the controls. Comparisons were made based on two subphenotypes of musical experience: musical aptitude and music education. In musically experienced participants, we observed the differential expression of 45 genes (27 up- and 18 down-regulated) and 97 genes (75 up- and 22 down-regulated) respectively based on subphenotype comparisons (rank product non-parametric statistics, pfp 0.05, >1.2-fold change over time across conditions). Gene ontological overrepresentation analysis (hypergeometric test, FDR < 0.05) revealed that the up-regulated genes are primarily known to be involved in the secretion and transport of dopamine, neuron projection, protein sumoylation, long-term potentiation and dephosphorylation. Down-regulated genes are known to be involved in ATP synthase-coupled proton transport, cytolysis, and positive regulation of caspase, peptidase and endopeptidase activities. One of the most up-regulated genes, alpha-synuclein (SNCA), is located in the best linkage region of musical aptitude on chromosome 4q22.1 and is regulated by GATA2, which is known to be associated with musical aptitude. Several genes reported to regulate song perception and production in songbirds displayed altered activities, suggesting a possible evolutionary conservation of sound perception between species. We observed no significant findings in musically inexperienced participants.


Apparently there are about 7,000 music therapists in the United States and about 6,000 in Europe.  One of the target groups for these therapists is children with autism.
So should parents pay out their cash for music therapy classes?  Well a very recent large study carried out in nine countries by a team from Norway suggests you might not want to open your wallet.
I must say that I hold a different view and that this simplistic kind of research is rather unhelpful. 
From the research in this blog we know that people who develop a love of music express a measurable biological effect, which does indeed look beneficial.
How do you develop a love of music, or indeed dance? Well you have to be exposed to it and engage in it.
Music therapy is all about engaging in music.
Monty, now aged 14 with ASD, has been dancing almost since he was walking, in great part because his then assistant loved music.  Later on you can start to make your own simple music, later you can sing and eventually play an instrument.  This process takes years.  
Music therapy is just a start, years later you can be trampolining to Abba, lying in bed listing to classical music, or just playing the piano.  But it is a long road.
In the recent research they gave 5 months of music therapy to 364 children aged 4 to 7 and then tested their social skills using the Autism Diagnostic Observation Schedule (ADOS).  Their social skill score did not improve. I am not sure why they picked this variable to measure.
This is yet more flawed research, which will then be quoted as fact by others.
You could make a study on teaching judo to kids with autism. I think you would find after 5 months it did not improve their social skills, but those who continue for 5 years might benefit considerably, versus those sat on the sofa watching videos on their iPads.
Clearly not everyone likes music, or indeed judo. Many kids with more severe autism have little interest in anything and so they need a lot more encouragement than typical kids.
The only way to find out if children can develop an interest in music, sport or anything else is to expose them to it at a young age. This is all music therapy is supposed to be, it is not meant to be a cure for anything. 

Researchers found that children with ASD in nine countries scored similarly on a test of their social skills whether or not they had received the music therapy.

"Music therapy - like many other interventions that have been suggested - does not improve autism symptoms," said senior author Christian Gold, of the Grieg Academy Music Therapy Research Center and Uni Research Health in Bergen, Norway.

ASDs are developmental disorders that can lead to social, communication and behavioral challenges. The U.S. Centers for Disease Control and Prevention estimates that one in 68 children in the U.S. has been diagnosed with an ASD.

The anecdotal link between music and ASD goes back many years, Gold and colleagues write in JAMA. During music therapy, a person helps a child spontaneously make music through singing, playing and movement.

There are about 7,000 music therapists in the United States and about 6,000 in Europe, the researchers write.

For the new study, the researchers recruited 364 children ages 4 to 7 years from 10 treatment centers between 2011 and 2015. The centers were in Australia, Austria, Brazil, Israel, Italy, Korea, Norway, the UK and the U.S.

All of the children received the usual care a child with ASD would receive in their region, but half of the children were randomly assigned to also get music therapy.

Usual care could range from early intensive behavioral interventions, to speech and language therapy, to sensory-motor therapies and medications, Gold told Reuters Health by email.

"Music therapy is also among the interventions that have been recommended when it is available," he said. "Some parents who are frustrated with behavioral interventions may experience it as bringing back the joy of being with their child in a natural way."

After five months of therapy, the researchers did not find a difference between the two groups of children on a measure of social skills.

Gold said parents should continue to pursue music therapy if they feel it's a good match for their children, but don't expect it to be a so-called treatment.

The article below is quite a good one:

The study itself:

In this issue of JAMA, Bieleninik and colleagues1 present the results of a large, well-designed, multicenter randomized clinical trial (RCT) of improvisational music therapy for young children with autism spectrum disorder (ASD). Music therapy is “a systematic process of intervention wherein the therapist helps the client to promote health, using musical experiences and the relationships that develop through them.”2 Among 364 children aged 4 to 7 years, over 5 months, the mean scores on the Autism Diagnostic Observation Schedule (ADOS), social affect domain, decreased from 14.08 to 13.23 among children randomized to improvisational music therapy and from 13.49 to 12.58 among those randomized to enhanced standard care, a mean difference in change scores of 0.06 (95% CI, −0.70 to 0.81), with no significant differences between groups.

How Much Music?
I think you need music lessons twice a week to have a meaningful impact and, as with all therapies, you need more practice at home.  Most kindergartens have music and dance as part of their activities. Taken together it is not so hard to get quite a lot of exposure to music at a young age. Then, if the child really likes music, you just keep going.  


Is music therapy a quick fix for autism? Definitely not.
Is music therapy a fun way to engage many young children with autism? The recent research does not say so, but it is clear that many people, with all levels of autism severity, can enjoy music and participate in it.
I think we should put music alongside sport, as a useful activity that young children should be encouraged to engage in.   It can be a struggle to get some people with autism to engage in anything, which is where a music therapist comes in.
Is it worth the investment in time and money? That all depends on the child and the therapist. Buying a piano, 7 years ago, was certainly one of my better investments; but you do also need a lot of lessons.  The end result is someone with a genuine love of many kinds of music and I expect he is now in the cortisol lowering, gene expression modifying category of the musically experienced.
Five months of unspecified music therapy may not be enough to see results and quite possible those results are not increased sociability anyway.

Wednesday 11 March 2015

Wombles and Music Therapy for Autism

Instead of giving you my rather heavy post about epigenetics and autism, today’s post is much more down to earth.

Medical opinion in North America has long been very much in favour of ABA (Applied Behavioural Analysis) as the only “scientifically proven” therapy for the core symptoms of autism.

This evidence is actually quite flaky, so much so that in the very "evidence driven" United Kingdom, their highly regarded National Institute for Health and Care Excellence (NICE) does not even mention ABA, let alone endorse it, in their guidance note in how to manage autism.

ABA is a potent tool to manage autism and provides a flexible framework to teach people who do not respond to traditional teaching methods.  However, it is no cure for autism and the old studies suggesting that almost 50% of kids going to an intensive ABA program will lose their autism diagnosis after two years are nonsense.  They just serve to over-extend the expectations of parents entering ABA therapy and increase guilt among those not able to afford it.

All of our ABA consultants to date have agreed with this view.  In highly intelligent kids with mild autism, maybe 50% can improve so far to lose their diagnosis; but maybe they would have done so after two years without ABA?

Selective interpretation of evidence

A therapy that is sometimes included alongside swimming with the dolphins, as being non-evidence based, is music therapy.

Music and dance is used extensively with many typical kids of kindergarten age, mainly as a fun activity.

I myself would have previously thought that was all there was to it.  But after several years of observing the effect of lots of music on Monty, aged 11 with ASD, there really is much more to it.  

Monty’s original assistant was (and remains) really into music, and so he had lots of music and dance from a very young age.  A few years later we bought a piano and he started piano lessons.

It appears that for some people, singing is easier than talking, or perhaps it is that music encourages communication.  We saw in a post long ago that singing lowers your level of cortisol, the stress hormone. 

Music (and dance) appear to unlock something deep within. (Perhaps the music gene)

Who are the Wombles

The Wombles are furry inhabitants of a burrow on Wimbledon Common in London, England.  They live by collecting up and reusing all the rubbish humans leave behind.

The Wombles were created by British author Elisabeth Beresford, and originally appeared in a series of children's novels from 1968. A stop motion animated series of five minute episodes was made between 1973 and 1975.  A new TV series, with CGI animation, is in production, along with a movie.

Wombles on Sunday Morning

Last Sunday morning, when half the house was sleeping, Monty was sitting in the kitchen with his iPad; then he selected his Wombling song on Youtube.  He then started singing his own mixture of the original lyrics and his creation, at full volume.  Listen a bit harder and he was singing in two languages.

Given most kids with classic autism really struggle to communicate, this is quite remarkable and light years ahead of where he used to be.

I am a convert to both ABA and music therapy, but I do not think you can prove the effectiveness of either.  Anecdotal evidence, but lots of it, is as good as it can realistically get.

The moral of the story is that if you set the bar too high, you will reject valid therapies alongside all the quack therapies. 

Also, you may have to persevere for a long time to kindle that interest in music; but as our ABA consultant commented recently, the biggest problem her older clients have, is that they have nothing to do – no hobbies, no interests.  Keep up with those lessons.


Sunday 14 July 2013

Scooter Therapy

One of the most read posts on this blog is the one about Lego Therapy.  We have lots of small Lego sets and they are indeed great as both tools and toys.  They are not exactly cheap, once you buy many of them.

Monty, now aged 10 and with autism, is also a big fan of music therapy, which regularly shows up as a favourite therapy among parents, although it is hard to prove its value scientifically.  In fact the other day Monty went to his first grown up ballet.  He went to see Sleeping Beauty and sat transfixed throughout the performance and behaved impeccably during the interval, surrounded by all the grown-ups in the audience.  It is clear that music has a power of its own, particularly over certain children.

Scooter therapy is my invention.  All you need is one of those new type of three wheeled scooters, which can be bought very cheaply.

Now, in any ABA programme you will have to work on both fine motor and gross motor skills, so that means finely controlling your hands to write neatly, or cut shapes with scissors and gross motor skills like kicking a football or throwing a basketball.  When you apply these skills to riding a bicycle, it may, or may not work.  Typical kids start with a small bike with stabilisers and then you soon take of the stabilisers and away they go.  You take for granted that the kids have situational awareness.  So if there is a wall straight ahead, they will apply the brakes, or swerve to avoid it.  If there is a nice row of flowers on one side, the kid may glance at them, but will soon focus again on where the bike is going.  With autistic kids the world can be very different, they may have no problem pedalling, but balance, using the brakes and situational awareness can be problems.

So I decided several months ago to take a step backwards and buy a little scooter and forget about bicycles.  The new type of three wheel scooters are great, they are more stable than the old type of two wheel scooter, but you still have to lean to turn left or right.  You can scoot on one leg, lean forwards to go fast and brake using your spare foot, or stand on the rear wheel.  All this fun and you are only a few centimetres off the ground, so it is hardly dangerous.

Well, after a few months, Monty has mastered his scooter and learnt about paying attention to obstacles, like oncoming bikes and pedestrians.  When something interesting comes into sight, he dismounts to investigate.  He can even safely scoot downhill on the pavement, while holding his ice cream and remember to stop at road junctions. 

This may not sound like much, but it is quite a transformation.  Sometimes to take two steps forward,  you have to first take one step backwards.

Scooting is also fun and you can go quite a long way.  A couple of months ago we managed to go 6km around a lake, which would have been a struggle on foot.

So, if you do not already have one, invest in a scooter.  They even have them for adults.