Review question

We reviewed the evidence about the effect of music therapy for autistic people. We compared results from people receiving music therapy (or music therapy added to standard care) with results from people receiving a similar therapy without music ('placebo' therapy), standard care or no therapy at all.

Background

Autism is a lifelong neurodevelopmental condition that affects how people perceive the world around them, and how they communicate with and relate to others. Thus, social interaction and social communication are among the central areas of difficulty for autistic people. Music therapy uses music experiences and the relationships that develop through them to enable people to relate to others, to communicate, and to share their feelings. In this way, music therapy addresses some of the core problems of autistic people. Music therapy has been applied in autism since the early 1950s. Its availability to autistic people varies across countries and settings. The application of music therapy requires specialised academic and clinical training. This helps therapists in tailoring the intervention to the specific needs of the person. We wanted to investigate whether music therapy helps autistic people compared with other options.

Search date

The evidence is current to August 2021.

Study characteristics

We included 16 new studies in this update, so the evidence in this review now rests on 26 studies with a total number of 1165 participants. The studies examined the short- and medium-term effect of music therapy interventions (three days to eight months) for autistic children, youth, and young adults in one-to-one or group settings. None of the studies reported funding by an agency with a commercial interest in the result of the studies; reported sources of support included governmental, university and foundation funding; in three studies, support was provided by a music therapy association.

Key results

Music therapy compared with 'placebo' therapy or standard care probably increases the chance of overall improvement by the end of therapy, likely improves quality of life and total autism symptom severity immediately after therapy, and probably does not increase adverse events. From the available evidence, we cannot tell whether music therapy has any effects on social interaction, and verbal and non-verbal communication at the end of therapy.

Quality of the evidence

The evidence we found in this review is of very low to moderate certainty. This means that future research may change these findings and our confidence in them. We found that music therapy is probably effective regarding global improvement, quality of life, total autism symptom severity and adverse events measured at the end of therapy based on the moderate certainty of the evidence in these domains. It remains unclear whether music therapy has an effect on social interaction, non-verbal communication and verbal communication at the end of therapy since the certainty of evidence was low to very low. Reasons for limited certainty of the evidence were issues with study design and blinding (i.e. those who applied outcome measures often knew whether or not participants had received music therapy, which may have influenced their assessments).

Authors' conclusions

Music therapy compared with 'placebo' therapy or standard care probably increases the chance of overall improvement by the end of therapy. It also probably helps to enhance quality of life, and lessen symptom severity. Music therapy probably does not increase adverse events. We cannot tell whether music therapy may help with social interaction, non-verbal communication and verbal communication at the end of therapy. Most of the included studies featured interventions that correspond well with music therapy in clinical practice concerning methods and settings. This new evidence is important for autistic people and their families as well as for policymakers, service providers and clinicians, to help in decisions around what intervention to choose, and in the planning of resources. More research with adequate design (i.e. producing reliable evidence) looking at areas that matter to autistic people is needed. Because long-term outcomes of therapy matter to autistic people and their families, it is important to specifically examine how long the effects of music therapy last.